Experience Inc. Jobs

Care Manager II- Bright Start Maternity | Kent County, DE | RN

Location: New Castle, DE

Primary Job Function: Medical Management

ID**: 34500

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you.

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.

Discover more about us at www.amerihealthcaritas.com.

MUST LIVE IN OR NEAR KENT COUNTY, DELAWARE, TO QUALIFY FOR CONSIDERATION

Responsibilities:

The Care Manager/Coordinator (RN/SW) assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager/Coordinator (RN/SW) is responsible for engaging 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 function as a single point-of-contact and be an advocate for members in the care coordination program. In addition, the Care Manager/Coordinator will oversee these same care management activities within assigned practices to ensure the ACDE delivers high-quality care management services in accordance with the Plan, NCQA, Federal/State standards, and requirements.

• Assess Members through face-to-face encounters and by telephone to determine the care coordination and care management needs of all referred Members

• Complete a comprehensive person-centered assessment that includes physical health history, mental health history, social determinants of health, and supportive needs

• Coordinate physical, behavioral health, and social services

• Provide medication management, including regular medication reconciliation and support of medication adherence

• Identify problems/barriers for care coordination and appropriate care management interventions

• Create a plan of care to assist Members in reducing/resolving problems and/or barriers so that members may achieve their optimal level of health.

• Identify goals and assign priority with associated timeframes for completion; share goals with the Member and family as appropriate

• Identify and implement the appropriate level of intervention based upon the Member’s needs and clinical progress

• Schedule follow-up calls as necessary and make appropriate referrals. Implement actions to address Member issues. Document progress towards meeting goals and resolving problems.

• Coordinate care and services with the Community Health Navigator, and Member, and the Member's caregiver as appropriate, PCP, Specialist, and Facility/Vendor Providers

• Provide transitional care management. Meet regularly with designated partners regarding Plan identified Members for care management. Assist with reducing/resolving problems and/or barriers so that the ACDE Care Coordinator may provide Members with high-quality care management services.

• Participate in regularly scheduled meetings as needed

Education/Experience:

• Associate Degree in Nursing is required

• Bachelor's (or higher) degree in a health-related field is preferred

• Current and unrestricted RN licensure in Delaware is required

• Minimum of 3 years of labor & delivery, postpartum, and/or OBGYN office experience

• Minimum of 3 years experience as a Case Manager, preferably providing telephonic case management

• Certification as a case manager is preferred

• Ability to meet deliverables within designated timeframes, strong organization, and communication skills

• Proficiency using MS Office (Word, Excel, Outlook), internet applications, and electronic medical record and documentation programs

• Ability to travel within Kent County for home visitations

• Possibility of 50% travel required in Kent County, Delaware

• Must have own vehicle, valid driver’s license, and valid car insurance

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 (PTO) including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement, and more.

EOE Minorities/Females/Protected Veterans/Disabled