Amerihealth Caritas Health Plan - Harrisburg, PA
posted 14 days ago
About the position
At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations 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 would like to hear 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.
Responsibilities
- Assist members appropriate for care management and care coordination services in achieving their optimal level of health through self-management.
- Engage the member, member care giver and providers to assess, plan and establish individual member goals.
- Facilitate and coordinate care for the members while assuring quality and use of cost-effective resources.
- Function as a single point of contact and be an advocate for members in the care management program.
- Complete comprehensive person-centered assessment inclusive of physical health history, mental health history, social determinants of health and supportive needs.
- Coordinate physical, behavioral health and social services.
- Provide medication management, including regular medication reconciliation and support of medication adherence.
- Identify problems/barriers for care coordination and appropriate care management interventions.
- Create a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health.
- Identify goals and assign priority with associated time frames for completion. Share goals with the member and family as appropriate.
- Identify and implement the appropriate level of intervention based upon the member's needs and clinical progress.
- Schedule follow up calls as necessary, make appropriate referrals. Implement actions to address member issues. Document progress towards meeting goals and resolving problems.
- Coordinate care and services with the Care Coordinator, Community Health Navigator, and member, member care giver as appropriate, PCP, Specialist, and Facility/Vendor Providers.
Requirements
- Bachelor's Degree in Nursing or health related field.
- Current and unrestricted Registered Nurse licensure in Pennsylvania.
- 3+ years of clinical experience at the bedside (as a Registered Nurse) working with medically fragile pediatric patients in an acute care, home care, or special needs clinic.
- 3+ years of Case Management experience, preferably telephonic within a managed care organization, desired.
- Eligible to sit for Case Management certification after 12 months of employment. Must obtain this certification after 2 years of employment.
- Demonstrated proficiency working within a Windows 11 environment to include MS Office (Excel, Word, Outlook) and electronic medical record and documentation programs.
- Valid driver's license and car insurance required.
- Ability to work Monday-Friday from 8:30a to 5:00p EST.
Benefits
- 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.
