What are the responsibilities and job description for the RN Case Manager / LCSW position at AmeriHealth Caritas?
We’re looking for the next generation of healthcare leaders.
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 healthcare 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. Together we can build healthier communities. 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.
- This position will require regional travel up to 90%.;
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. Serves as the primary point of contact for the care team that includes Members, physicians as well as community supports to guide members in achieving their optimal level of health. Utilizes strong assessment and communication skills, critical thinking, and clinical knowledge to identify issues, gaps in care and barriers to care. The Care Manager II develops a plan of care through shared decision making with the Member / caregiver and in collaboration with providers and other care team members to improve the Member’s health status, compliance with treatment plans and promote self-management. The Care Manager II is also responsible for the following :
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.
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.
Qualified candidates must be local to Asheville, NC.
90% travel to conduct home visits with members and complete PCS assessments.
Requirements for LCSW : Master’s degree in social work and current, unrestricted North Carolina LCSW license in good standing.
Associate degree in nursing required, Bachelor’s degree preferred.
Case management experience, preferably within a managed care organization desired.
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 knowledge and experience in assessing Member’s situation, developing a care plan, and teaching self-management.
Proficiency using MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record and documentation programs.
Diversity, Equity, and Inclusion
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.
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.
