Title: Care Manager
Location
Philadelphia, PA
Primary Job Function
Medical Management
Job ID
38903
Job Description:
About this job:
The Care Manager assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager engages the member, member caregiver, and providers to assess the plan and establish individual member goals. Will facilitate and coordinate care for the members while assuring quality and use of cost-effective resources. The position will be a single point of contact and advocate for care coordination program members. In addition, the Care Manager will oversee these same care management activities within assigned practices to ensure the delivery of high-quality care management services by Plan, NCQA, Federal/State standards, and requirements.
Assess members by telephone to determine care coordination and care management needs for all referred members.
Completes a comprehensive person-centered assessment that includes physical and mental health history, social determinants of health, and supportive needs.
Coordinates physical, behavioral health, and social services.
Provides medication management, including regular medication reconciliation and medication adherence support.
Identifies problems/barriers for care coordination and appropriate care management interventions.
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 and family as appropriate.
Identifies and implements the appropriate level of intervention based on the member’s needs and clinical progress.
Schedules follow-up calls as necessary and makes appropriate referrals. Implements actions to address member issues.
Documents progress towards meeting goals and resolving problems.
Coordinates care and services with the Community Health Navigator, member, member caregiver as appropriate, PCP, Specialist, and Facility/Vendor Providers.
Meets regularly with designated partners regarding Plan-identified members for care management and assists with reducing/resolving problems or barriers to providing members with high-quality care management services.
Participate in regularly scheduled meetings as needed.
Education & Qualifications:
A bachelor’s degree as a registered nurse in PA is required.
3 years of professional practice experience and active state RN license.
3 to 5 years of case management experience is preferred.
Home health nursing experience preferred
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.
