Job Description

Role Overview

The Care Manager II assists members appropriate for care coordination and case management services in achieving their optimal level of health. The Care Manager II is responsible for engaging the member and providers to assess, plan and establish individual member goals. Will facilitate and coordinate care for the members while assuring quality and use of cost-effective resources. The position will function as a single point of contact and be an advocate for members in the care coordination program. Assess members to determine care coordination and case management needs for all referred members.

Work Arrangement

• Remote

• Must reside in state of Pennsylvania

Responsibilities

• Conduct telephone assessments to determine care coordination and management needs
• Complete comprehensive person-centered assessments covering physical and mental health history, social determinants, and supportive needs
• Coordinate physical, behavioral health, and social services
• Manage medications, including reconciliation and adherence support
• Identify problems/barriers and implement appropriate care management interventions
• Develop care plans to help members achieve optimal health, setting goals and priorities
• Share goals with members and families as appropriate
• Implement interventions based on member needs and clinical progress
• Schedule follow-up calls and make referrals as necessary
• Document progress towards goals and problem resolution
• Coordinate care with Community Health Navigators, caregivers, PCPs, specialists, and facility/vendor providers
• Meet regularly with partners to address care management issues and ensure high-quality services
• Participate in scheduled meetings as needed
  
   

Education and Experience

• Bachelor’s Degree in Nursing (RN) required
• Minimum of 3 years clinical practice experience in med-surg and/or home care required. Experience with behavioral health desired
• Minimum of three years of experience as a case manager, preferably providing telephonic case management.
• Certification as a case manager preferred

Licensure

• Valid driver’s license with car insurance
• Current and unrestricted Registered Nurse licensure in Pennsylvania required

Skills & Abilities

• Proficiency using MS Office (Word, Excel, Outlook), internet applications, and electronic medical record and documentation programs
• Ability to meet deliverables within designated timeframes, strong organization and communication skills

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, PA, 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 include remote options, hybrid work schedules, competitive pay, paid time off, 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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