Pediatric Care Management RN II

1 week ago

Philadelphia, Pennsylvania, United States Amerihealth Caritas Health Plan Full time
Pediatric Care Management RN II

Your professional journey begins here. We are in search of innovative health care leaders.

At AmeriHealth Caritas, we are dedicated to assisting individuals in accessing care, maintaining wellness, and fostering healthy communities.

As a prominent entity in health care solutions, we provide our employees the chance to make a significant impact on the lives of countless individuals through our extensive range of products, services, and acclaimed programs.

AmeriHealth Caritas is eager to welcome skilled and passionate professionals to our organization. Together, we can cultivate healthier communities. If you are motivated to make a difference, we invite you to connect with us.

Based in Newtown Square, AmeriHealth Caritas is a mission-oriented organization with over three decades of expertise. We offer comprehensive, outcome-focused care to those who require it the most.

Our services include integrated managed care products, pharmaceutical benefit management, specialty pharmacy services, behavioral health services, and various administrative solutions.

Learn more about our mission at

Key Responsibilities:


The Care Manager II plays a vital role in assisting members who are suitable for care management and coordination services in reaching their highest level of health through self-management.

This position is accountable for engaging with members, their caregivers, and providers to evaluate, plan, and set individual member objectives.

The Care Manager II will facilitate and coordinate care for members while ensuring quality and the utilization of cost-effective resources.

This role serves as a single point of contact and acts as an advocate for members within the care management program.


  • Conduct assessments of members through in-person meetings or phone calls to identify care coordination and management needs for all referred individuals.
  • Complete a thorough person-centered assessment that includes physical health history, mental health history, social determinants of health, and supportive needs.
  • Coordinate physical, behavioral health, and social services;
  • Manage medication, including regular reconciliation and support for adherence;
  • Identify challenges/barriers to care coordination and implement appropriate care management interventions.
  • Develop a care plan to assist members in overcoming issues and barriers to achieve their optimal health.
  • Set goals and prioritize them with associated timelines for completion. Share these goals with the member and family as appropriate.
  • Determine and apply the necessary level of intervention based on the member's needs and clinical progress.
  • Schedule follow-up calls as needed, make suitable referrals, and take action to address member concerns. Document progress towards meeting goals and resolving issues.
  • Collaborate with the Care Coordinator, Community Health Navigator, and members, caregivers, as appropriate, along with PCPs, specialists, and facility/vendor providers.
  • Provide transitional care management. Regularly meet with AMH/CIN regarding identified members for care management, assisting in addressing problems and barriers to ensure high-quality care management services.

Qualifications:

  • Bachelor's Degree in Nursing.
  • Current and unrestricted Registered Nurse licensure in Pennsylvania.
  • A minimum of 3 years of clinical experience at the bedside (as a Registered Nurse) working with medically fragile pediatric patients in acute care, home care, or special needs clinics.
  • At least 3 years of Case Management experience, preferably in a telephonic capacity within a managed care organization.
  • Eligible to pursue Case Management certification after 12 months of employment, with a requirement to obtain this certification within one year.
  • Proven proficiency in a Windows 11 environment, including MS Office (Excel, Word, Outlook) and electronic medical record/documentation systems.
  • A valid driver's license and car insurance. Must be willing to use a personal vehicle for in-person visits with members as necessary.
Diversity, Equity, and Inclusion

At AmeriHealth Caritas, we strive to ensure that everyone feels valued, supported, and free to express their true selves. Our commitment to equity ensures that all associates have a fair opportunity to reach their full potential. We actively implement these principles by demonstrating integrity and respect in our daily actions.

We unite to advocate against injustice and dismantle barriers to create a more inclusive and equitable workplace.

Embracing the diverse thoughts and perspectives within our workforce enriches our company, making it more vibrant, innovative, and better equipped to support the communities we serve.

We prioritize the well-being of our associates so they can focus on promoting the health of our members.

Our Comprehensive Benefits Package


Flexible work solutions, including remote options, hybrid work schedules, competitive compensation, paid time off including holidays and volunteer opportunities, health insurance coverage for you and your dependents from Day 1 of employment, 401(k), tuition reimbursement, and more.

#PH

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