Unclassified

AmeriHealth Caritas - Aiken, SC

Full-time - Entry Level

Remote - Aiken, SC

Insurance Carriers and Related Activities

About the position

The Field-Based Remote Behavioral Health Case Worker at AmeriHealth Caritas plays a crucial role in managing and coordinating care for members with behavioral health conditions and complex medical needs. This position serves as the primary point of contact for a multidisciplinary care team, which includes members, physicians, and community support services. The Case Worker is responsible for guiding members towards achieving their optimal health through effective communication, assessment, and critical thinking skills. The role involves developing personalized care plans in collaboration with members and their caregivers, ensuring that treatment plans are adhered to and that members are empowered to manage their health effectively. In addition to care coordination, the Case Worker supports members during transitions of care, providing education on discharge plans, coordinating pharmacy needs, and ensuring medication reconciliation. Regular follow-ups are essential to monitor progress and update care plans based on the evolving needs of members. The Case Worker also establishes connections with community and medical teams to facilitate comprehensive care and addresses any quality of care issues that may arise. Documentation is a key responsibility, requiring timely and accurate records of member interactions in electronic care management platforms. The Case Worker must also develop a thorough understanding of the organization's policies, procedures, and community resources to effectively support members. Face-to-face visits at various locations, including members' homes and community settings, are part of the role, emphasizing the importance of personal engagement in the care process. Overall, this position is integral to fostering healthier communities by ensuring that members receive the care and support they need.

Responsibilities

• Manage and coordinate care for members with behavioral health conditions and complex medical needs.
• Serve as the primary point of contact for the care team, including members, physicians, and community supports.
• Utilize assessment and communication skills to identify issues and gaps in care.
• Develop a plan of care through shared decision-making with members and caregivers.
• Support members during transitions of care through assessment and coordination of services.
• Review medication lists and coordinate pharmacy needs with community pharmacists.
• Evaluate and update care plans based on member progress and preferences.
• Establish collaboration points with community, medical, and behavioral health teams.
• Maintain accurate documentation of member interactions in electronic care management platforms.
• Monitor service utilization and coordinate with other payer sources, making appropriate referrals.
• Develop knowledge of care management programs, policies, and community resources.
• Identify cases for care management rounds and follow up with providers on recommendations.
• Support a positive workplace environment and collaborate with diverse member populations.
• Conduct face-to-face visits for education and assessment.

Requirements

• Bachelor's Degree in Human Services or related field; Master's degree preferred.
• 2 years of professional experience working with members with Serious Mental Illness (SMI).
• 2 years of social services experience engaging with clients and assessing their needs.
• Proficiency in MS Office and electronic medical record programs.
• Ability to manage a caseload of up to 60 members.
• Strong documentation and record-keeping skills.
• Expertise in assessing member situations and developing care plans.
• Skilled in effective communication and health education presentation.
• Willingness to travel and access members' homes and community locations.

Nice-to-haves

• Experience with Electronic Case Management Platforms (e.g., Jiva).
• Knowledge of community resources and programs related to behavioral health.

Benefits

• Flexible work solutions including remote options and hybrid work schedules.
• Competitive pay.
• Paid time off including holidays and volunteer events.
• Health insurance coverage for employees and dependents from Day 1.
• 401(k) plan.
• Tuition reimbursement.