AmeriHealth Caritas Care Manager II, Shift Care, Registered Nurse* in Philadelphia, Pennsylvania
Care Manager II, Shift Care, Registered Nurse*
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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, Care Coordination, the Case Manager assumes the overall accountability for the identification of members/consumers (M/C) appropriate for care coordination and/or case management program services. The Case Management/Care Coordination (CM/CC) program is a blended model that provides comprehensive case management and disease management services to the highest risk health plan M/Cs. Completes a comprehensive case management assessment and gathers pertinent information about the M/C’s needs by interviewing the M/C, appropriate family members, physicians, ancillary health professionals and others as necessary. Is responsible for the development of the M/C’s interdisciplinary individualized plan of care including short term and long term goals in collaboration with the M/C. Monitors and evaluates the M/C’s progress towards meeting goals and initiates appropriate interventions as necessary. 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. Refers M/C as appropriate for other services such as Special Needs and Pharmacy. Works closely with the assigned Case Management Technician, to manage the M/C’s care needs. Assumes a leadership role in monitoring appropriate utilization of the M/C’s benefits and in coordinating with other payor sources. Understands, supports, and practices within the scope of the State of Pennsylvania Nurse Practice Act and the Case Management Practice Standards established by the Case Management Society of America (CMSA). This position receives no direct or indirect incentive for determinations made in applying utilization and case management guidelines, selecting providers for services, or in the assignment of M/C benefits.
- Unrestricted PA RN licensure and 3 years clinical practice experience in pediatrics.
- 3 to 5 years of Case Management experience required, telephonic case management experience preferred.
- Proficiency utilizing MS Office Suite, including Excel, Word, and Outlook. Familiarity utilizing electronic medical record and documentation programs.
- Eligible for Certification in Case Management within one year of accepting position. Successful attainment of Case Management certification is highly recommended.
EOE Minorities/Females/Protected Veterans/Disabled