Resource Coord II

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At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's 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’d like to hear from 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.

Discover more about us at www.amerihealthcaritas.com.

As part of the care coordination team, the Resource Coordinator supports the development of and executes on the outreach strategy in a certain territory for the purposes of influencing health outcomes and member engagement. The position will function as a single point of contact and be an advocate for members in the care coordination program identified as emerging risk. This position is responsible for establishing and cultivating relationships with members, community stakeholders and providers. ;Responsibilities include, but are not limited to:

• Actively assists with emerging risk members following emergency department visits and/or acute episodes of care involving at a minimum one of the following services: inpatient psychiatric stay, ambulatory surgery, hospital inpatient stay, and rehabilitation facility services.;
• Assistance shall include but not be limited to: appointment setting, referrals and linkages to services, coordination of DME, referrals to wellness programs, and coordination of prior authorizations as needed to support the member’s timely access to services in the community
• Coordinates with the member and/or provider on am appropriate discharge plan;
• Assist in closing social determinants of health and care gaps through appointment assistance, coordinating transportation, connection to community resources, provider collaboration and wellness programs
• Assesses members through face-to-face encounters and by telephone/virtual interaction to determine care coordination needs and interventions for all referred members. ;Completes appropriate assessments and screenings related to their member.
• Schedules follow up calls as necessary, makes appropriate referrals. Implements actions to address member issues.
• Establishes connection and acts as the primary ACFC contact to a targeted member population through home visits, community visits and outreach calls.
• Exercises judgment and discretion in the coordination of care by handling basic care follow up tasks and collaborating with AmeriHealth Caritas care coordination teams, community-based health care providers, and other organizations. ;
• Informs members of the required actions to fulfill HEDIS, EPSDT, and Plan requirements and other referred outreach, through phone calls or home visits, and encourages them to comply.
• Assists in addressing members’ barriers to care and to encourage/foster relationships with their medical/dental providers (medical/dental homes).
• Assists in addressing members’ barriers to care and to encourage/foster relationships with their medical/dental providers (medical/dental homes).
• Creates a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health.;
• ;Identifies goals and assigns priority with associated time frames for completion. ;Shares goals with the member, provider/s, and family as appropriate. Documents progress towards meeting goals and resolving problems.
  
  

Education/ Experience:

• Associate’s Degree in Health Care, Human Services or a related field or equivalent work experience
• Bachelor’s Degree
• Active LPN can be substitute for required education
• Candidate must possess a valid driver’s license and be willing and able to drive a car
• 3 to 5 years experience
• Community based care experience preferred
• Behavioral health experience preferred
• Previous experience in presenting health education materials to individuals and small groups
• Knowledge and understanding of medical terminology and disease processes;
• Ability to effectively communicate preventive health and health management philosophies to member’s and agencies
• Comprehensive knowledge of Medicaid requirements and plan, policies and procedures
• Knowledge of managed care
• Up to 50% of time will be spent traveling.
  
  

Diversity, Equity, and Inclusion

At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

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.