Care Manager II - Pediatrics (DE)

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 www.amerihealthcaritas.com.

The Care Manager/Coordinator (RN/SW) assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager/Coordinator (RN/SW) is responsible for engaging the member, member care giver 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. In addition the Care Manager/Coordinator will oversee these same care management activities within assigned practices to ensure the ACDE delivers high quality care management services in accordance with Plan, NCQA, Federal/State standards and requirements.

Assess members through face to face encounter and by telephone to determine care coordination and care management needs for all referred members. Completes comprehensive person centered assessment inclusive of physical health history, mental health history, social determinants of health and supportive needs. Coordinates physical, behavioral health and social services. Provides medication management, including regular medication reconciliation and support of medication adherence. Identifies problems/barriers for care coordination and appropriate care management interventions. Creates a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health. Identifies goals and assigns priority with associated time frames for completion. Shares goals with the member and family as appropriate. Identifies and implements the appropriate level of intervention based upon the member’s needs and clinical progress. Schedules follow up calls as necessary, makes appropriate referrals. Implements actions to address member issues. Documents progress towards meeting goals and resolving problems. Coordinates care and services with the Community Health Navigator, and member, member care giver as appropriate, PCP, Specialist, and Facility/Vendor Providers. Provides transitional care management. Meets regularly with designated partners regarding Plan identified members for care management, assist with reducing/resolving problems and or barriers so that the ACDE Care Coordinator may provide members with high quality care management services. Participate in regularly scheduled meetings as needed.