Care Manager II

Amerihealth Caritas•,

7d•Remote

About The Position

The Care Manager partners with members, caregivers, providers, and community resources to assess needs, develop individualized care plans, address barriers to care, and promote self-management. The role provides comprehensive care coordination and case management for members with complex medical, behavioral health, and social needs to help them achieve their optimal level of health and improve overall health outcomes. This is a fully remote position, and candidates must reside in Ohio. Some travel may be required within a 60-mile radius to meet members at provider offices and community locations. Reliable high-speed internet is required, with minimum speeds of 50 Mbps download and 5 Mbps upload. Associates in states where reimbursement is required by law, regulation, or contract may be eligible for internet reimbursement.

Requirements

Master’s degree in Social Work.
At least 3 years of professional clinical experience working with adult and/or pediatric populations in Behavioral Health, Physical Health, Oncology, Care Transitions/Discharge Planning, Community Health, Ambulatory Care, or Acute Care.
Current, active, and unrestricted Ohio Licensed Independent Social Worker (LISW) license.
Valid driver’s license and car insurance.
Demonstrated experience assessing member needs, developing care plans, coordinating services, and promoting self-management.
Ability to work independently while managing multiple priorities in a fast-paced environment.
Strong knowledge of care management, care coordination, case management, and population health principles.
Ability to perform comprehensive member assessments and develop effective care plans.
Knowledge of social determinants of health and community-based resources.
Strong clinical judgment and critical thinking skills.
Ability to prioritize, organize, and manage multiple cases simultaneously.
Excellent time management and follow-through skills.
Strong communication and relationship-building skills with members, caregivers, providers, and community partners.
Ability to work independently while collaborating effectively within a multidisciplinary team.
Strong documentation and navigation skills for care management systems.
Proficiency with electronic medical records (EMR), care management platforms, and Microsoft Office applications.
Flexible and adaptable, with comfort working in a dynamic and evolving healthcare environment.
Must reside in Ohio.
Reliable high-speed internet with a minimum bandwidth of 50 Mbps download and 5 Mbps upload.

Nice To Haves

Previous case management or care coordination experience.
Experience within a managed care organization is highly preferred.

Responsibilities

Assess members to determine eligibility and need for care coordination and case management services.
Complete comprehensive, person-centered assessments of physical health, behavioral health, psychosocial needs, environmental factors, and social determinants of health.
Identify clinical, behavioral, and social barriers affecting member health and develop appropriate intervention strategies.
Develop, implement, and monitor individualized care plans to improve health outcomes and promote self-management.
Establish short- and long-term goals with members and caregivers, including measurable timelines and action plans.
Coordinate physical, behavioral, and social services, as well as community-based resources, to meet member needs.
Provide medication management support, including medication reconciliation, adherence monitoring, and member education.
Implement appropriate care management interventions based on member acuity, needs, and clinical progress.
Conduct follow-up outreach, care plan reviews, and ongoing assessments to monitor progress and address emerging needs.
Make referrals to internal and external resources and facilitate access to services.
Document member interactions, care coordination activities, interventions, and outcomes in accordance with organizational and regulatory requirements.
Collaborate with providers, caregivers, and interdisciplinary teams to ensure continuity of care and successful care transitions.
Support members with complex conditions, including behavioral health disorders, chronic conditions, maternal health needs, oncology diagnoses, and transition-of-care needs.