AmeriHealth Caritas Care Manager II in Charleston, South Carolina
Care Manager II
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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.
Under the supervision of the Supervisor, Rapid Response, the Rapid Response Care Manager II assists the member/consumer (M/C) appropriate for rapid response and case management program services in achieving their optimal level of health. The Case management/Rapid Response program is a blended model that provides comprehensive case management and disease management services to the highest risk health plan members. The Rapid Response Care Manager II is responsible for engaging the M/C and their(s) providers to assess, plan and establish individual member goals. The Rapid Response Care Manager II monitors and evaluates the M/C's progress towards meeting goals and initiates appropriate interventions as necessary.
The Rapid Response Care Manager II serves as an advocate for the member and acts as a liaison between the M/C and other community based agencies, facilities, providers, and practitioners in coordinating the M/C's care. The Rapid Response Care Manager II will facilitate and coordinate care for the M/C while assuring quality and use of cost-effective resources. The Rapid Response Care Manager understands, supports, and practices within the Case Management Practice Standards established by the Case Management Society of America (CMSA).
The Rapid Response Care Manager II Principle accountabilities are, but not limited to:
- Assess M/C to determine rapid response and case management needs for all referred M/Cs. Performs health risk assessment to determine appropriateness of rapid response and case management program services for all referred M/Cs. The assessment includes a health history, support systems, functional abilities and limitations, history of chronic and acute illnesses and immediate and future needs.
- Completes health risk assessment of environmental, Psycho-social and support needs.
- For M/Cs identified for rapid response: Outreaches to coordinate with PCP and M/C for appropriate treatment plan to optimize appropriate interventions and access to and utilization of health maintenance and restoration services. This includes routine PCP and specialists visits, appropriate outpatient therapeutic interventions, psycho-social needs, housing needs, Special Needs, and health screenings.
- Identifies problems/barriers for rapid response and appropriate care management interventions.
- Obtains verbal and or written M/C consent for case management services. When the M/C is unable to give consent, identifies appropriate guardian or next of kin to obtain consent. Educates M/C to the case management process and how and when information is shared with third parties. Advises M/C to the purpose of rapid response and scope of services offered.
- Assists M/C in reducing/resolving problems and barriers so that M/Cs may achieve their optimal level of health and basic human needs. Includes M/Cs family members and other members of treatment team as appropriate. Consults with appropriate medical personnel colleagues for clinical interventions.
- Documents as required by policies and procedures. Identifies and implements the appropriate level of intervention based upon the M/Cs needs and progress. Identifies necessary follow-up calls to facilitate needs.
- Advocates for the M/C as necessary. Respects the M/Cs cultural differences and they pertain to implementing and meeting needs of the M/C.
- Associate degree or Bachelor’s degree is required
- Active RN license in the state of South Carolina.
- Minimum of 3+ years of Case Management experience preferred
- Must have experience and be comfortable with using technology (e.g. MS Office including Outlook, Word, and Excel) and electronic medical records.
EOE Minorities/Females/Protected Veterans/Disabled