Triage Care Manager

Qualified candidates must live in CST or EST time zones.

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, 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.

Responsibilities

Under the supervision of the Manager of the Care Management Department, the Triage Care Manageris responsible for assisting Participants in coordinating care for Long Term Services & Supports.& closing care gaps. The Triage Care Manager will assist with Cases referred to the Special Needs Unit and complex cases referred by Service Coordination, Utilization Management ,or various other sources. Additionally, the Triage Care Manager will practice case management within the scope of their licensure for our Emergency Room Diversion cases (based on the standards of the discipline).

Work Arrangement

Remote with availability to work Eastern Standard Time 8:30am-5:00pm

Additional Triage Care Manager responsibilities

• Monitors various alerts regarding Participant resource utilization
• Monitors the utilization of assigned participants over a time-limited period
• Conducts assessments or surveys to identify problems/barriers for care coordination and appropriate intervention, including Participant education
• Identifies and implements actions to address Participant issues
• Collaborates with Medicare Care Managers from various MCOs to effectively coordinate care
• Collaborates with nursing facilities and other providers of care to coordinate care
• Notifies assigned Service Coordinators of service utilization and related care coordination
• Makes referrals and appropriate follow-ups

Education

• Bachelor's Degree in Nursing or health related field preferred.
• Current and unrestricted Registered Nurse licensure in Pennsylvania or an Unrestricted Compact License.
• Social Worker with a unrestricted Pennsylvania clinical license.

Experience

• Registered Nurse, graduated from an accredited Diploma or Social Worker, from a Master's Degree program.
• Minimum of 3 years of nursing experience, in a related clinical setting with Discharge Planning.
• Required Managed Care experience.
• Case Management experience preferred.
• Required Acute Discharge Planningor Skill Nursing Facility experience.
• Proficiency with Microsoft Office Suite (Word, Excel, Power Point).

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.