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Care Manager

AmeriHealth Caritas

Dover, DE(remote)

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JOB DETAILS
SKILLS
Administrative Skills, Behavioral Health, Biotech and Pharmaceutical, Broadband, Calendar Management, Case Management, Community Health, Community and Social Services, Compensation and Benefits, Demographics, Diversity, Documentation, Driver's License, Electronic Medical Records, Establish Priorities, Follow Through, Health Plan, Healthcare, Identify Issues, Internet Application, Licensed Clinical Social Worker (LCSW), Managed Care, Medical Record System, Medications, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft Product Family, Microsoft Word, National Committee for Quality Assurance (NCQA), Organizational Skills, Pediatrics, Pharmacy, Problem Solving Skills, Product Management, Project/Program Coordination, Psychiatry and Mental Health, Quality Management, Reconciliation, Registered Nurse (RN), Set Goals, Social Work, Team Player, Time Management, Training/Teaching, Transitional Care, Treatment Plan, Willing to Travel
LOCATION
Dover, DE
POSTED
Today
Role Overview:


The Care Manager (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 (RN/SW) engages behavioral health members, member caregivers, 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 will oversee these same care management activities within assigned practices to ensure the ACDE delivers high-quality care management services following Plan, NCQA, Federal/State standards and requirements.


Work Arrangement: Remote with up to 50% required travel throughout the state of Delaware.


Responsibilities:


+ Assess members through face-to-face encounters 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 and 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 caregiver as appropriate, PCP, Specialist, and Facility/Vendor Providers.

+ Provides transitional care management. Meets regularly with designated partners regarding plan-identified members for care management, assists 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.


Experience:


+ Minimum of 3 to 5 years’ experience with complex medical and behavioral health adult and pediatric populations required

+ Ability to work with specific care teams and other engagement community partners preferred.

+ Case management experience, preferably within a managed care organization, is desired.

+ Proficient with various technologies including Microsoft Tools and Medical Record systems.


Licensure:


• Current, unrestricted DE RN license in good standing or unrestricted DE LMSW / LCSW license with experience in managing medical complexities.

• Valid Driver’s License.


Skills & Abilities


+ Demonstrate ability to be self-directed, independent, adaptive, flexible to change, and able to collaborate as a team member in a fast-paced, ever-changing environment.

+ Demonstrate awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population.

+ Proficiency using MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record and documentation programs.

+ Demonstrate strong organizational and time management skills with the ability to promptly prioritize and follow through on multiple items.

+ Demonstrate knowledge and experience in assessing members’ situations, developing a care plan, and teaching self-management.


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.


For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.


Your career starts now. We’re looking for the next generation of health care 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 health care 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, 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 .
As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

About the Company

A

AmeriHealth Caritas

Leaders in health care solutions for those most in need

AmeriHealth Caritas is the nation's leader in providing comprehensive health care solutions for those in most need and the chronically ill. We impact the lives of more than 5.7 million members nationwide. With more than 30 years of experience managing care for individuals and families in publicly-funded programs, we have become known for developing innovative solutions that help improve health outcomes while reducing costs.

Our mission, our goal

Our mission is to help people get care, stay well and build healthy communities. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP - plus behavioral health, pharmacy benefits management and third-party management and administrative services.

COMPANY SIZE
5,000 to 9,999 employees
INDUSTRY
Healthcare Services
FOUNDED
1985
WEBSITE
http://www.amerihealthcaritas.com

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