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Pediatric Care Manager II, BSN
2 months ago
Your career begins here. We are seeking the next generation of healthcare leaders.
At AmeriHealth Caritas, we are dedicated to assisting individuals in accessing care, maintaining wellness, and fostering healthy communities.
As a leading entity in healthcare solutions, we provide our associates with the chance to influence the lives of millions through our extensive range of products, services, and award-winning initiatives.
AmeriHealth Caritas is in search of skilled, passionate professionals to become part of our mission. Together, we can create healthier communities. If you are driven to make a positive impact, we want to hear from you.Based in Newtown Square, AmeriHealth Caritas is a mission-focused organization with over 30 years of expertise. We deliver comprehensive, outcome-oriented care to those who require it the most.
We provide integrated managed care solutions, pharmaceutical benefit management, specialty pharmacy services, behavioral health services, and various administrative offerings.
Learn more about us atKey Responsibilities:
The Care Manager II supports members eligible for care management and coordination services in reaching their highest level of health through self-management.
The Care Manager II is accountable for engaging with the member, their caregivers, and healthcare providers to evaluate, plan, and set individual member objectives.
This role will facilitate and coordinate care for members while ensuring quality and the use of cost-effective resources.The position 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 medications, including regular medication reconciliation and support for adherence;
- Identify challenges/barriers to care coordination and appropriate 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 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 the Care Coordinator, Community Health Navigator, and member, caregiver, as appropriate, as well as with primary care providers, specialists, and facility/vendor providers.
- Provide transitional care management. Collaborate regularly with AMH/CIN regarding members identified for care management, assisting in resolving issues and barriers 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 special needs clinics.
- At least 3 years of Case Management experience, preferably telephonic within a managed care organization, is preferred.
- Eligible to sit for Case Management certification after 12 months of employment. Must obtain this certification within one year of employment.
- Proven proficiency in a Windows 11 environment, including MS Office (Excel, Word, Outlook) and electronic medical record and documentation systems.
- Valid driver's license and car insurance. Must be willing to use a personal vehicle for in-person visits with members as necessary.
At AmeriHealth Caritas, we strive to ensure that everyone feels valued, supported, and comfortable being themselves. Our commitment to equity means that all associates have a fair opportunity to reach their full potential. We actively uphold these principles every day by acting with integrity and respect.
We unite to speak out against injustice and dismantle barriers to foster a more inclusive and equitable workplace.
Embracing the diverse thoughts and perspectives that comprise our workforce makes our organization more vibrant, innovative, and better equipped to support the individuals and communities we serve.
We prioritize the well-being of our associates so they can focus on 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.
