Role Overview:
The Care Manager is dedicated to managing and coordinating care, services, and social determinants of health for Members with complex health needs, including acute, chronic, and behavioral health conditions. Acting as the primary contact for the care team—which includes Members, physicians, and community supports—this role is essential in guiding members towards their optimal health outcomes. Utilizing strong assessment and communication skills, critical thinking, and clinical expertise, the Care Manager identifies care gaps and barriers while developing a comprehensive care plan through collaborative decision-making with the Member and their caregivers. This role is vital in improving health status and promoting self-management.
Work Arrangement:
- Remote
- Community Visits - Residency in Rock Hill or Richland, South Carolina Required
Responsibilities:
- Support Members through transitions of care by assessing needs, coordinating services, providing education on discharge plans, and evaluating the effectiveness of the care plan.
- Review medication lists, educate Members on pharmacy needs, and advise on side effects and mitigation strategies.
- Continuously evaluate, monitor, and update care plans based on regular follow-ups with Members and caregivers.
- Establish contacts to collaborate with community, medical, and behavioral health teams.
- Ensure accurate and timely documentation of Member interactions in relevant care management platforms.
- Monitor service utilization, coordinate with other payers, make referrals, and address quality of care issues.
- Develop knowledge of care management programs, regulations, community resources, and insurance benefits.
- Collaborate with clinical teams to present cases and follow up on recommendations for optimal Member outcomes.
- Foster a positive workplace environment while sharing knowledge and supporting a diverse Member population.
- Conduct face-to-face visits for assessments or education at Members' residences, healthcare facilities, or community locations as needed.
- Perform additional duties as assigned.
Education and Experience:
- BSN required.
- A minimum of 3 years of professional experience in pediatric home care or acute care is necessary.
- Experience in the Foster Care System, Department of Social Services, or Department of Juvenile Justice is preferred.
- Face-to-face engagement with Members in the community is required.
- At least 3 years of case management experience is preferred.
- Essential proficiency in MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record systems.
Licensure:
- A current and unrestricted Registered Nurse (RN) license in good standing in South Carolina or a compact state is required.
- A valid driver's license with car insurance is necessary.
Your career starts now. We are seeking passionate individuals to join our team at AmeriHealth Caritas, where we are committed to helping people access care, maintain wellness, and foster healthy communities. As a leader in health care solutions, you will have the opportunity to make a significant impact on the lives of millions across the nation. Together, we can build healthier communities.
With over 30 years of experience, AmeriHealth Caritas delivers integrated managed care products, pharmaceutical benefit management, behavioral health services, and more to those most in need.
Our Comprehensive Benefits Package:
- Flexible work solutions, including remote options and hybrid work schedules.
- Competitive compensation.
- Paid time off, including holidays and volunteer opportunities.
- Health insurance coverage from Day 1 for you and your dependents.
- 401(k) plan.
- Tuition reimbursement and more.