Resource Coordinator II

Your career starts now. 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. 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.

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.

Responsibilities:

As part of the care coordination team, the Resource Coordinator supports developing and executing the outreach strategy in a particular territory to influence health outcomes and member engagement. The position will be a single point of contact and advocate for members in the care coordination program identified as emerging risk. This position establishes and cultivates 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 care episodes involving at least 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 community services.
• Coordinates with the member and/or provider on an 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 and makes appropriate referrals.
• Implements actions to address member issues.
• Establishes connections and acts as the primary ACFC contact for a targeted member population through home visits, community visits, and outreach calls.
• Exercises judgment and discretion in coordinating care by handling basic 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 encourages/fosters relationships with their medical/dental providers (medical/dental homes).
• Assists in addressing members’ barriers to care and encourages/fosters 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.
• Share goals with the member, provider, and family as appropriate. Documents progress towards meeting goals and resolving problems.

 Education & Qualifications:

• Associates degree in healthcare, human services, or a related field or equivalent work experience.
• Bachelor’s degree preferred.
• Active Licensed Practical Nurse (LPN) can be substituted for required education.
• 3 to 5 years of experience with community-based care and 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.
• Effectively communicate preventive health and health management philosophies to members and agencies.
• Comprehensive understanding of Medicaid requirements and plan, policies, and procedures
• Knowledge of managed care.
• Up to 50% of the time will be spent traveling.
• Candidate must possess a valid driver’s license and be willing and able to drive a car.

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 one, 401(k) tuition reimbursement and more.