Pediatric Care Manager

About the role

Role Overview The Pediatric Care Manager supports members in achieving optimal health through self-management. Engaging with members, caregivers, and providers, the role involves assessing plans, setting individual goals, and coordinating care to ensure quality and cost-effective resources. This position serves as a single point of contact and advocates for care coordination program members, overseeing care management activities within assigned practices to meet Plan, NCQA, and Federal/State standards. Work Arrangement: Fully Remote; must reside in Pennsylvania.

Responsibilities

• Conduct telephone assessments to determine care coordination and management needs
• Complete comprehensive person-centered assessments covering physical and mental health history, social determinants, and supportive needs
• Coordinate physical, behavioral health, and social services
• Manage medications, including reconciliation and adherence support
• Identify problems/barriers and implement appropriate care management interventions
• Develop care plans to help members achieve optimal health, setting goals and priorities
• Share goals with members and families as appropriate
• Implement interventions based on member needs and clinical progress
• Schedule follow-up calls and make referrals as necessary
• Document progress towards goals and problem resolution
• Coordinate care with Community Health Navigators, caregivers, PCPs, specialists, and facility/vendor providers
• Meet regularly with partners to address care management issues and ensure high-quality services
• Participate in scheduled meetings as needed

Education and Experience

• Associate Degree in Nursing required. Bachelor of Science in Nursing preferred
• 3 years of professional practice experience
• Minimum of 3 years of case management experience
• Behavioral Health and managing chronic conditions experience preferred
• Home Health or Acute Care nursing experience preferred

Licensure

Current and unrestricted Registered Nurse licensure in PA or compact licensure with PA required.

Skills and Abilities

• Demonstrate ability to be self-directed, independent, adaptive, flexible to change, and able to collaborate as a team member in a fast-paced, ever-changing environment.
• Demonstrate awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population.
• Proficiency using MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record and documentation programs.
• Demonstrate strong organizational and time management skills with the ability to promptly prioritize and follow through on multiple items.
• Demonstrate knowledge and experience in assessing members’ situations, developing a care plan, and teaching self-management.

Benefits

• 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

AmeriHealth Caritas is a mission-driven organization headquartered in Newtown Square with more than 30 years of experience delivering comprehensive, outcomes-driven care. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. As a national leader in health care solutions, we provide associates the opportunity to impact the lives of millions through our award-winning programs and services. Learn more at www.amerihealthcaritas.com.