Nursing Care Specialist
7 days ago
Job Overview
AmeriHealth Caritas is seeking a highly skilled Nursing Care Specialist to join our team in South Carolina. This role will involve providing exceptional care management services to vulnerable populations, specifically those in the foster care system.
Responsibilities:
- Support members during transitions of care through assessment, coordination of care, education of discharge plans, referrals, and evaluation of plan effectiveness.
- Review medication lists and educate members with pharmacy needs, counseling on side effects and mitigation strategies for specific treatment protocols.
- Evaluate, monitor, and update care plans through regularly scheduled follow-up contacts based on member/caregiver progress, needs, and preferences.
- Establish points of contact to collaborate with identified community, medical, and/or behavioral health teams.
- Maintain timely, complete, and accurate documentation of member interactions in ACFC electronic care management platforms where applicable.
- Monitor appropriate utilization and coordinate services with other payer sources, make referrals, identify and escalate quality of care issues.
- Develop working knowledge of ACFC electronic care management platforms, care management programs, policies, standard operating procedures, workflows, member insurance products and benefits, community resources and programs, and applicable regulatory, state, and NCQA requirements.
- May identify cases to be presented at care management rounds and follows up with providers on recommendations to achieve optimal outcomes for members.
- Support a positive workplace environment, collaborate, and share clinical knowledge and skills to support culturally and demographically diverse member populations.
Requirements:
- Bachelor of Science in Nursing (BSN) required; current and unrestricted Registered Nurse (RN) license in good standing in South Carolina or compact state.
- Minimum 3 years professional experience in pediatric home care or acute care; prior experience in Foster Care System, Department of Social Services, or Department of Juvenile Justice as an RN preferred.
- Proficiency in MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical records/documentation systems essential.
- Valid driver's license with car insurance required.
About AmeriHealth Caritas
AmeriHealth Caritas is a mission-driven organization with over 30 years of experience delivering comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management, and specialty pharmacy services, among others.
Estimated Salary Range: $60,000 - $80,000 per year
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