AmeriHealth Caritas Care Manager II RN--Maternity in Charleston, South Carolina

Care Manager II RN--Maternity

Location: Charleston, SC

Telecommuter?: Yes

ID**: 14092

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 .

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.

Note to Applicants: This position will require a South Carolina RN license and Labor and Delivery/Mother Baby/post-partum care experience.

Responsibilities:

Under the supervision of the Supervisor ICM, the Care Manager II RN assists member with appropriate care coordination and case management services to achieve their optimal levels of health. The Care Manager is responsible for engaging members and providers to assess, plan and establish individual member goals. The Care Manager will facilitate and coordinate care for members while assuring quality and use of cost-effective resources. The Care Manager will function as a single point of contact and be an advocate for members in the care coordination program.

Principal Accountabilities:

  • Assesses members to determine care coordination and case management needs for all referred members.

  • Completes comprehensive assessments of environmental, psycho-social and support needs.

  • Identifies problems/barriers for care coordination and appropriate care management interventions.

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

  • Shares goals with members and their families as appropriate.

  • Identifies and implements the appropriate level of intervention based upon the member’s needs and clinical progress.

  • Schedules follow-up calls as necessary and makes appropriate referrals to management.

  • Documents progress towards meeting goals and resolving problems.

  • Coordinates care and services with members and family members as appropriate, PCP’s, specialists and facility/vendor providers.

  • Collaborates with department staff to assist members in receiving quality and cost effective services.

  • Facilitates access to entitlement programs and/or community resources.

  • Monitors and documents member’s on going progress.

  • Participates in the discharge planning process for hospitalized members.

  • Assists members in the transitional process from home to a skilled nursing facility for long-term placement.

  • Arranges for services/appointments.

  • Participates on project teams as requested.

  • Maintains confidentiality of all company, provider and member information.

  • Identifies and refers potential and actual quality issues to quality management staff.

  • Keeps up-to-date with case management initiatives.

  • Attends scheduled meetings.

  • Obtains necessary educational requirements to maintain professional licensure and certifications.

  • Complies with AMFC and HIPAA confidentiality requirements to protect member personal identifiable health information.

  • Performs other related duties and projects as assigned.

Education, Training and Experience:

  • Graduate of an accredited college or university with at least a Bachelor’s in Science degree (BSN) or equivalent education and experience.

  • Three (3) years practice experiencein Labor and Delivery, Mother / Baby, post-partum care.

  • Three (3) to five (5) years of Care Management experience preferred.

  • Knowledge of Windows and Microsoft Office applications.

  • Familiar with accreditation processes such as URAC/NCQA.

Licenses, Registrations or Certification:

  • Active/Clear South Carolina RN license required.

  • Certification in Case Management preferred.

EOE Minorities/Females/Protected Veterans/Disabled