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Pediatric Care Manager II, BSN
2 months ago
Your career in health care begins here. We are in search of dedicated health care professionals who are committed to enhancing the well-being of our communities.
At AmeriHealth Caritas, we are devoted to facilitating access to care, promoting wellness, and fostering healthy communities.
As a prominent entity in health care solutions, we empower our associates to make a significant impact on the lives of countless individuals through our extensive range of products, services, and award-winning initiatives.
AmeriHealth Caritas is eager to welcome skilled and passionate individuals to our organization. Together, we can cultivate healthier communities. If you are driven to make a difference, we would love to connect with you.Located in Newtown Square, AmeriHealth Caritas is a mission-oriented organization with over three decades of experience. We provide comprehensive, outcome-focused care to those who require it the most.
Our offerings include integrated managed care products, pharmaceutical benefit management, specialty pharmacy services, behavioral health services, and various administrative solutions.
Learn more about our mission atKey Responsibilities:
The Care Manager II plays a crucial role in assisting members eligible for care management and coordination services to achieve their highest level of health through effective self-management.
This position is responsible for engaging with members, their caregivers, and healthcare providers to assess, plan, and establish personalized member goals.
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 primary point of contact and advocate for members within the care management program.
- Conduct assessments of members through in-person visits or telephone calls to identify care coordination and management needs for all referred individuals.
- Complete thorough, person-centered assessments that encompass physical health history, mental health history, social determinants of health, and supportive needs.
- Coordinate services across physical health, behavioral health, and social services;
- Manage medication needs, including regular medication reconciliation and support for adherence;
- Identify challenges/barriers to care coordination and implement appropriate care management interventions.
- Develop a personalized care plan to assist members in overcoming challenges and achieving their optimal health.
- Set goals and prioritize them with associated timelines for completion, sharing these goals with members and their families as appropriate.
- Determine and implement the necessary level of intervention based on the member's needs and clinical progress.
- Schedule follow-up calls as needed, make appropriate referrals, and take action to address member concerns. Document progress towards meeting goals and resolving issues.
- Coordinate care and services with Care Coordinators, Community Health Navigators, members, caregivers, primary care providers, specialists, and facility/vendor providers.
- Provide transitional care management, collaborating regularly with AMH/CIN regarding members identified for care management, assisting in problem resolution to ensure high-quality care management services.
Qualifications:
- Bachelor's Degree in Nursing.
- Current and unrestricted Registered Nurse licensure in Pennsylvania.
- 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 specialized clinics.
- At least 3 years of experience in Case Management, 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 certification within one year.
- Proficient in operating within a Windows 11 environment, including MS Office (Excel, Word, Outlook) and electronic medical record systems.
- Possess a valid driver's license and car insurance. Willingness to use a personal vehicle for in-person member visits as required.
At AmeriHealth Caritas, we strive to create an environment where everyone feels valued, supported, and empowered to be their authentic selves. Our commitment to equity ensures that all associates have a fair opportunity to reach their full potential. We actively embody these principles by acting with integrity and respect.
We unite to challenge injustice and dismantle barriers, fostering a more inclusive and equitable workplace.
By celebrating and embracing the diverse perspectives that comprise our workforce, we enhance our company's vibrancy, innovation, and ability to serve the communities we support.
We prioritize the well-being of our associates so they can focus on promoting the health of our members.Our Comprehensive Benefits Package
We offer flexible work solutions, including remote options and hybrid 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.
