AmeriHealth Caritas Manager Integrated Care Management in Baton Rouge, Louisiana

Manager Integrated Care Management


Description

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

At AmeriHealth Caritas, we’re 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’d like to hear from you.

Headquartered in Philadelphia, 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.

Responsibilities:

  • Plans, organizes and directs the development and implementation of Case Management. Ensures staff is properly trained, oriented and provided with regular professional development. Identifies opportunities for improvement, both clinical and administrative, and assists the Director in the strategic planning processes for these functions.
  • Coordinates and implements the development of recommended policies and programs. Coordinates, establishes and monitors achievement of departmental goals and objectives. Responsible for achievement of assigned NCQA standard compliance and compliance with all applicable State and Federal laws, as well as achievement of assigned incented health outcomes.
  • Directs effectiveness of existing programs and services identifies and evaluates new programs and services to address cost effectiveness, proposed process improvements and to achieve compliance with NCQA and State incented health outcomes.
  • Participates in and supports the corporate Medical Management Strategy.
  • Directs the case management activities to be in compliance with the PerforMED Model for case management.
  • Develops and recommends a consolidated operating budget and submits to Director for approval. Reviews and authorizes disbursement of funds in accordance with operating procedures. Monitors monthly financial statements for areas of responsibility to determine and recommend adjustments.
  • Directs the coordination of positive inter and intra communication to share information regarding quality of care, member issues and cost effective services. Works across departmental lines to achieve objectives.
  • Creates and supports an environment that fosters teamwork, cooperation, respect and diversity. Establishes and maintains positive communication and professional demeanor with AMFC employees, providers and acts as liaison with outside entities as required. Demonstrates and supports commitment to corporate goals and mission.
  • Performs other related duties and projects as assigned.

Key Competencies/Success Factors:

  • Excellent organizational, analytical and interpersonal skills required.
  • Ability to develop and design programs to address cost efficiencies and quality health outcomes.
  • Ability to develop and maintain operational budget.
  • Excellent written and verbal communication skills.
  • Proficient PC skills in a windows based environment.

Education/Experience:

  • Bachelor’s Degree.
  • Bachelor’s degree in Nursing or other Health related field preferred.
  • MSW licensure and three (3) years professional practice experience.
  • Master’s degree or equivalent experience preferred
  • Registered Nurse.
  • Active and unrestricted RN license.
  • Current unrestricted Social Work License.
  • 8-10 years progressive experience in healthcare delivery required with at least; 5 years of experience in managed health care.; Minimum of 5 years managerial experience required. Minimum of 1year project management experience required preferably at management level. Two years managed Medicare experience preferred; One year managed Medicaid experience preferred.