Job Description
Position Summary
The Care Manager II (RN/SW) provides remote care management and care coordination for members enrolled in a Highly Integrated Dual Eligible Special Needs Plan (HIDE D-SNP). This role serves as the primary point of contact for assigned members, supporting complex medical, behavioral health, and social needs through assessment, care planning, member engagement, and coordination of services.
The ideal candidate has experience managing complex Medicare and Medicaid populations, strong clinical judgment, and the ability to build member relationships in a remote environment.
Required Licensure
Current, unrestricted South Carolina license in good standing as one of the following:
+ Registered Nurse (RN)
+ Licensed Independent Social Worker-Clinical Practice (LISW-CP)
+ Licensed Master Social Worker (LMSW)
+ Licensed Professional Counselor (LPC)
Education & Experience
Required:
+ Associate's degree in Nursing, Master's degree in Social Work, Counseling, or related healthcare field
+ Minimum 3 years of clinical, case management, care coordination, or managed care experience
+ Experience working with adults with chronic and complex medical conditions
+ Strong computer skills, including Microsoft Office and electronic documentation systems
Preferred:
+ BSN
+ Medicare, Medicaid, D-SNP, HIDE D-SNP, LTSS, or managed care experience
+ Remote care management experience
+ Knowledge of South Carolina Medicaid programs, waiver services, and community resources
+ CCM or other care management certification
Key Responsibilities
+ Conduct comprehensive member assessments to identify medical, behavioral, and social needs.
+ Develop and maintain individualized, person-centered care plans.
+ Coordinate care across providers, behavioral health services, community resources, and support programs.
+ Address social determinants of health, including housing, transportation, food security, and caregiver needs.
+ Perform medication reconciliation and support medication adherence.
+ Provide transitional care management following hospital, emergency department, or skilled nursing facility admissions.
+ Engage members through ongoing outreach, education, and health coaching.
+ Collaborate with interdisciplinary care teams to improve member outcomes.
+ Maintain accurate documentation and comply with CMS, NCQA, Medicare, Medicaid, and organizational requirements.
+ Manage an assigned caseload while meeting quality and productivity expectations.
Knowledge, Skills & Abilities
+ Knowledge of Medicare, Medicaid, and dual-eligible populations.
+ Strong assessment, critical thinking, and care coordination skills.
+ Excellent communication and member engagement abilities.
+ Experience addressing behavioral health and social determinants of health.
+ Ability to manage multiple priorities in a remote work environment.
+ Commitment to delivering high-quality, member-centered care.
Work Environment
+ Primarily remote position.
+ Occasional travel may be required for training, meetings, or business needs.
Ideal Candidate: An experienced RN or Social Worker with Medicare/Medicaid care management experience who thrives in a remote environment and is passionate about improving outcomes for complex, high-risk dual-eligible members.
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.
The Care Manager II (RN/SW) provides remote care management and care coordination for members enrolled in a Highly Integrated Dual Eligible Special Needs Plan (HIDE D-SNP). This role serves as the primary point of contact for assigned members, supporting complex medical, behavioral health, and social needs through assessment, care planning, member engagement, and coordination of services.
The ideal candidate has experience managing complex Medicare and Medicaid populations, strong clinical judgment, and the ability to build member relationships in a remote environment.
Required Licensure
Current, unrestricted South Carolina license in good standing as one of the following:
+ Registered Nurse (RN)
+ Licensed Independent Social Worker-Clinical Practice (LISW-CP)
+ Licensed Master Social Worker (LMSW)
+ Licensed Professional Counselor (LPC)
Education & Experience
Required:
+ Associate's degree in Nursing, Master's degree in Social Work, Counseling, or related healthcare field
+ Minimum 3 years of clinical, case management, care coordination, or managed care experience
+ Experience working with adults with chronic and complex medical conditions
+ Strong computer skills, including Microsoft Office and electronic documentation systems
Preferred:
+ BSN
+ Medicare, Medicaid, D-SNP, HIDE D-SNP, LTSS, or managed care experience
+ Remote care management experience
+ Knowledge of South Carolina Medicaid programs, waiver services, and community resources
+ CCM or other care management certification
Key Responsibilities
+ Conduct comprehensive member assessments to identify medical, behavioral, and social needs.
+ Develop and maintain individualized, person-centered care plans.
+ Coordinate care across providers, behavioral health services, community resources, and support programs.
+ Address social determinants of health, including housing, transportation, food security, and caregiver needs.
+ Perform medication reconciliation and support medication adherence.
+ Provide transitional care management following hospital, emergency department, or skilled nursing facility admissions.
+ Engage members through ongoing outreach, education, and health coaching.
+ Collaborate with interdisciplinary care teams to improve member outcomes.
+ Maintain accurate documentation and comply with CMS, NCQA, Medicare, Medicaid, and organizational requirements.
+ Manage an assigned caseload while meeting quality and productivity expectations.
Knowledge, Skills & Abilities
+ Knowledge of Medicare, Medicaid, and dual-eligible populations.
+ Strong assessment, critical thinking, and care coordination skills.
+ Excellent communication and member engagement abilities.
+ Experience addressing behavioral health and social determinants of health.
+ Ability to manage multiple priorities in a remote work environment.
+ Commitment to delivering high-quality, member-centered care.
Work Environment
+ Primarily remote position.
+ Occasional travel may be required for training, meetings, or business needs.
Ideal Candidate: An experienced RN or Social Worker with Medicare/Medicaid care management experience who thrives in a remote environment and is passionate about improving outcomes for complex, high-risk dual-eligible members.
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.
Numbers & Facts
| Location | Columbia, SC (Remote) |
| Industry | Healthcare Services |
| Company Size | 5,000 to 9,999 employees |
| Year Founded | 1985 |
| Website | http://www.amerihealthcaritas.com |
About Company
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.
Skills
- Behavioral Healthunmatched
- Case Managementunmatched
- Centers for Medicare and Medicaid Services (CMS)unmatched
- Coachingunmatched
- Communication Skillsunmatched
- Community Supportunmatched
- Computer Skillsunmatched
- Critical Careunmatched
- Diversityunmatched
- Documentationunmatched
- Emergency Careunmatched
- Health Planunmatched
- Healthcareunmatched
- Healthcare Providersunmatched
- Hospital Administrationunmatched
- Licensed Clinical Social Worker (LCSW)unmatched
- Managed Careunmatched
- Medicaidunmatched
- Medical Conditionsunmatched
- Medicareunmatched
- Medicationsunmatched
- Microsoft Officeunmatched
- Multitaskingunmatched
- National Committee for Quality Assurance (NCQA)unmatched
- Needs Assessmentunmatched
- Nursingunmatched
- Organizational Skillsunmatched
- Reconciliationunmatched
- Registered Nurse (RN)unmatched
- Riskunmatched
- Social Workunmatched
- Special Needsunmatched
- Transitional Careunmatched
- Willing to Travelunmatched
- Work From Homeunmatched
Level up your application
Professional resume templates
Browse dozens of recruiter approved resume templates, layouts and formats. Choose your favorite and make it your own in minutes.
Free resume templatesFree resume builder
Improve your existing resume or start from scratch and create a standout, ATS-friendly resume. Add job-specific content, download and apply.
Free resume builder