Job Description

Role Overview

The Care Manager II is responsible for managing and coordinating care, services, and social determinants of health for Members with acute, chronic, medically complex and/or behavioral health conditions and other health needs. Serves as the primary point of contact for the care team that includes Members, physicians as well as community supports to guide members in achieving their optimal level of health. Utilizes strong assessment and communication skills, critical thinking, and clinical knowledge to identify issues, gaps in care and barriers to care. The Care Manager II develops a plan of care through shared decision making with the Member/caregiver and in collaboration with providers and other care team members to improve the Member’s health status, compliance with treatment plans and promote self-management.

Work Arrangement

• Remote

Responsibilities

• Support Members during transitions of care through assessment, coordination of care, education of the discharge plan of care, referrals, and evaluation of the effectiveness of the plan
• Review medication list and educate Members with pharmacy needs, and counsel on side effects and mitigation strategies for specific treatment protocols
• Evaluate, monitor, and update the care plan through regularly scheduled follow-up contacts based on the Member/caregiver progress, needs and preferences
• Establishes 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 appropriate referrals, identify, and escalate quality of care issues
• Develop a 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 our culturally and demographically diverse Member population. Face-to-face visits may be required at the Member’s residence, provider’s office, hospitals, other acute location or community location for education and/or assessment
• Other duties as assigned

Education and Experience

• Requirements for LSW/LMSW: Bachelor' or Master’s degree in social work and current, unrestricted Ohio LSW/LCSW license in good standing
• Requirements for RN: Current, unrestricted Ohio RN license in good standing. Associate degree in nursing required. Bachelor’s degree preferred
• Case management experience, preferably within a managed care organization, desired
• Minimum of 3 years of professional practice working with adults and/or pediatric patients with behavioral and physical health disorders within an acute care, community health, or ambulatory setting;

Licensure

• C urrent, unrestricted Ohio RN license in good standing or current, unrestricted Ohio LSW/LCSW license in good standing
• Valid driver’s license and car insurance

Skills & Abilities

• Demonstrate ability to be self-directed, independent, adaptive, flexible to change, and able to collaborate as a member of a team in a fast-paced, ever-changing environment
• Demonstrate awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population
• Demonstrate strong organizational and time management skills with the ability to prioritize and follow through on multiple items in a timely manner
• Demonstrate knowledge and experience in assessing Member’s situation, developing a care plan, and teaching self-management
• Proficiency using MS Office (Word, Excel, Outlook, Teams), SharePoint, internet applications, and electronic medical record and documentation programs ; ; ; ; ; ; ; ;;

Your career starts now. We’re looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at ; . ;

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

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