Nurse Care Coordinator for Pediatric Health
3 days ago
The Nurse Care Coordinator is a critical role in enhancing the health outcomes of members with complex needs. As part of our team at AmeriHealth Caritas, you will be responsible for coordinating care, services, and social determinants of health for members with acute, chronic, medically complex, and/or behavioral health conditions.
Key Responsibilities:
Support members during transitions of care through assessment, coordination of care, education on discharge plans, referrals, and evaluation of plan effectiveness.
Review medication lists, educate members with pharmacy needs, and counsel on side effects and mitigation strategies for specific treatment protocols.
Evaluate, monitor, and update care plans through regular follow-up contacts based on member/caregiver progress, needs, and preferences.
Establish points of contact to collaborate with community, medical, and/or behavioral health teams.
Maintain timely, complete, and accurate documentation of member interactions in electronic care management platforms.
Monitor appropriate utilization and coordinate services with other payer sources, make referrals, identify, and escalate quality of care issues.
Develop a working knowledge of electronic care management platforms, care management programs, policies, standard operating procedures, workflows, member insurance products and benefits, community resources and programs, and applicable regulatory requirements.
May identify cases to be presented at care management rounds and follow up with providers on recommendations to achieve optimal outcomes for members.
Face-to-face visits may be required at member residences, provider offices, hospitals, or community locations for education and/or assessments.
Other duties as assigned.
Required Skills and Qualifications:
This is a community-facing role, and candidates must live in South Carolina.
BSN required, and a current and unrestricted Registered Nurse (RN) license in good standing in South Carolina or a compact state is essential.
A minimum of 3 years of professional experience in pediatric home care or acute care is required.
Prior experience in the Foster Care System, Department of Social Services, or Department of Juvenile Justice as an RN is preferred.
Must engage directly with identified members through face-to-face visits in the community as needed.
At least 3 years of case management experience is preferred.
Proficiency in MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record/documentation systems is necessary.
A valid driver's license with car insurance is required.
Benefits and Diversity:
We offer a comprehensive benefits package, including flexible work solutions, competitive pay, paid time off, health insurance coverage, 401(k), tuition reimbursement, and more. At AmeriHealth Caritas, we value diversity and inclusion, providing opportunities for personal growth and development in a supportive environment.
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