For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Headquartered in Newtown Square, PA, 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.

Job Overview

The 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 advocate for care coordination program members, overseeing care management activities within assigned practices to meet Plan, NCQA, Federal/State standards.

Work Arrangement

• Remote role
• Monday through Friday, 10:00 AM EST to 7:00 PM EST

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 & Experience

• Registered Nurse candidates must have Associate's Degree in Nursing; Bachelor's Degree is preferred
• Licensed Social Work candidates must have a Master's Degree in Social Work
• Minimum of 3 years of independent clinical practice experience to include homecare, community health or public health
• Minimum of 3 years of case management experience preferred
• Must be able to perform the responsibilities of the position either in English or in another language and complete the necessary assessment

Licensure

• Active and unencumbered compact state Registered Nurse license
• Active and unencumbered Social Work license

Skills and Abilities

• Demonstrated commitment to providing an exceptional member experience
• Ability to meet productivity measures through outreach calls and assessment and screening surveys to members
• Proficiency using MS Office to include Teams, Word, SharePoint, Excel, and Outlook
• Ability to type with accuracy and speed
• Clear, concise, and collaborative written and verbal communicator
• Must be bilingual, demonstrating the ability to speak both English and Haitian Creole, Spanish, or Russian

Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement, and more.