Care Manager II, RN (Philadelphia County, PA)

About the position

The Care Manager II, RN at AmeriHealth Caritas is responsible for assisting members in achieving their optimal level of health through care coordination and case management services. This role involves engaging with members and providers to assess needs, create care plans, and advocate for members within the care coordination program. The position is primarily remote but may require occasional visits to members in Philadelphia County.

Responsibilities

• Assist members appropriate for care coordination and case management services in achieving their optimal level of health.
• Engage members and providers to assess, plan, and establish individual member goals.
• Facilitate and coordinate care for members while assuring quality and cost-effective resource use.
• Function as a single point of contact and advocate for members of the care coordination program.
• Complete comprehensive assessments of environmental, psycho-social, and support needs.
• Identify problems/barriers for care coordination and appropriate care management interventions.
• Create a plan of care to assist members in reducing/resolving problems and achieving optimal health.
• Identify both short and long-term goals and associated time frames for completion.
• Share goals with the member and family as appropriate.
• Implement appropriate levels of intervention based on member needs and clinical progress.
• Schedule follow-up calls as necessary and make appropriate referrals.
• Document progress towards meeting goals and resolving problems.
• Coordinate care and services with members, family members, PCPs, specialists, and facility/vendor providers.

Requirements

• Bachelor's degree (or higher) in a health-related field is required; BSN preferred.
• Current and unrestricted Registered Nurse licensure in Pennsylvania is required.
• Minimum of three years of clinical practice experience in med-surg and/or home care required.
• Minimum of three years of experience as a case manager, preferably providing telephonic case management.
• Certification as a case manager preferred.
• Proficiency using MS Office (Word, Excel, Outlook), internet applications, and electronic medical record/documentation programs.
• Ability to meet deliverables within designated time frames, strong organization and communication skills.
• Valid driver's license with car insurance.

Nice-to-haves

• Experience with pediatrics and behavioral health desired.

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 you and your dependents on Day 1.
• 401(k).
• Tuition reimbursement.