Care Manager II

Role Overview

Responsible for managing and coordinating care, services, and social determinants of health for Members with acute, chronic, medically complex, and 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.

Responsibilities

• 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
• Establish points of contact in order 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, behavioral health facilities, and other acute location or community location for education and/or assessment

Education And Experience

• Minimum of 3 years of professional experience in related field required (i.e., SMI, home care, acute care, etc.)
• Prior experience in the Department of Social Services, or Department of Juvenile Justice
• Must engage directly with identified SMI members through face-to-face visits in the community as needed
• At least 3 years of case management experience is preferred
• Proficiency in MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record/documentation systems is essential

Licensure

• Must hold a current and unrestricted Registered Nurse (RN) license in good standing in South Carolina or a compact state OR LISW, LMSW, or LPCT

Benefits

• Flexible work solutions including remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events
• Health insurance coverage for you and your dependents starting Day 1
• 401(k) retirement savings plan
• Tuition reimbursement

About AmeriHealth Caritas

AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include 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.