What are the responsibilities and job description for the Care Manager II, Complex, RN/LCSW position at Amerihealth Caritas?
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AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience, delivering 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.
Job Description
The Care Manager II is responsible for managing and coordinating care, services, and social determinants of health for Members with acute, chronic, medically complex and/or behavioral health conditions and other health needs.
- Support Members during transitions of care through assessment, coordination of care, education of the discharge plan of care, referrals, and evaluation of the effectiveness of the plan.
- Review medication list and educate Members with pharmacy needs, and counsel on side effects and mitigation strategies for specific treatment protocols.
- Evaluate, monitor, and update the care plan through regularly scheduled follow-up contacts based on the Member/caregiver progress, needs and preferences.
- Establishes points of contact to collaborate with identified community, medical, and/or behavioral health teams.
- Maintain timely, complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable.
- Monitor appropriate utilization and coordinate services with other payer sources, make appropriate referrals, identify, and escalate quality of care issues.
- Develop a working knowledge of ACFC electronic care management platforms, care management programs, policies, standard operating procedures, workflows, Member insurance products and benefits, community resources and programs, and applicable regulatory, state, and NCQA requirements.
- May identify cases to be presented at care management rounds and follows up with providers on recommendations to achieve optimal outcomes for Members.
- Support a positive workplace environment, collaborate, and share clinical knowledge and skills to support our culturally and demographically diverse Member population. Face-to-face visits may be required at the Member's residence, provider's office, hospitals, other acute location or community location for education and/or assessment.
Requirements
- Qualified candidates must be local to Jacksonville, NC in order to engage with Members via face-to-face visits within the community, as needed.
- Requirements for LCSW: Master's degree in social work and current, unrestricted North Carolina LCSW license in good standing.
- Requirements for RN: Current, unrestricted North Carolina RN license in good standing. Associate degree in nursing required, Bachelor's degree preferred.
- Minimum of 3 years of professional clinical practice experience as a RN or LICSW working with adults with complex medical and behavioral health diagnoses within an acute care, homecare or community health setting.
- Case management experience, preferably within a managed care organization desired.
- Certification as a case manager preferred.
- Demonstrate ability to be self-directed, independent, adaptive, flexible to change, and able to collaborate as a member of a team in a fast-paced, ever-changing environment.
- Demonstrate awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population.
- Demonstrate strong organizational and time management skills with the ability to prioritize and follow through on multiple items in a timely manner.
- Demonstrate knowledge and experience in assessing Member's situation, developing a care plan, and teaching self-management.
- Proficiency using MS Office (Word, Excel, Outlook), internet applications, and electronic medical record and documentation programs.
- Valid driver's license.
About Us
AmeriHealth Caritas is committed to equity and inclusion, providing a fair opportunity for all associates to achieve their full potential. We put these principles into action every day by acting with integrity and respect.
Benefits
We offer a comprehensive benefits package, including flexible work solutions, competitive pay, paid time off, health insurance coverage, and tuition reimbursement.
