Care Manager II

Amerihealth Caritas • Dover, DE

10d • Remote

About The Position

The Care Manager (RN/SW) supports members who are appropriate for care management and care coordination services in reaching their optimal health through self-management. The role engages members, caregivers, and providers to assess needs, develop care plans, and set individual goals. It facilitates and coordinates care while promoting quality and cost-effective use of resources, and serves as a single point of contact and advocate for members in the care coordination program.

The Care Manager also oversees care management activities within assigned practices to help ensure that the ACDE provides high-quality services in accordance with Plan, NCQA, and Federal and State standards and requirements. The role is remote, with up to 50% required travel throughout Delaware. Remote or hybrid associates must have reliable high-speed internet with minimum speeds of 50 Mbps download and 5 Mbps upload.

Requirements

• Minimum of 3 to 5 years of experience with the behavioral health population.
• Current, unrestricted Delaware RN license in good standing, or unrestricted Delaware LMSW/LCSW license with experience managing medical complexities.
• Valid driver’s license.
• Ability to work independently and collaboratively, adapt to change, and function in a fast-paced, changing environment.
• Ability to work effectively with a culturally and demographically diverse population.
• Proficiency with Microsoft Office (Word, Excel, Outlook, Teams), internet applications, electronic medical records, and documentation programs.
• Strong organizational and time-management skills, including the ability to prioritize promptly and follow through on multiple items.
• Knowledge and experience assessing members’ situations, developing care plans, and teaching self-management.
• For remote or hybrid work, access to reliable high-speed internet with at least 50 Mbps download and 5 Mbps upload.

Nice To Haves

• Experience working with individuals with Intellectual Developmental Disabilities.
• Knowledge of the Life Span Waiver program.
• Ability to work with specific care teams and other engagement community partners.
• Case management experience, preferably within a managed care organization.

Responsibilities

• Assess referred members through face-to-face encounters and telephone calls to determine care coordination and care management needs.
• Complete comprehensive, person-centered assessments covering physical and mental health history, social determinants of health, and supportive needs.
• Coordinate physical health, behavioral health, and social services.
• Provide medication management, including regular medication reconciliation and support for medication adherence.
• Identify care coordination problems and barriers and select appropriate care management interventions.
• Create plans of care to help members reduce or resolve problems and barriers, including identifying goals, prioritizing them, setting completion time frames, and sharing goals with members and families as appropriate.
• Select and implement the appropriate level of intervention based on members’ needs and clinical progress.
• Schedule follow-up calls, make appropriate referrals, and take action to address member issues.
• Document progress toward goals and resolution of problems in the EMR system.
• Coordinate care and services with the Community Health Navigator, members and caregivers as appropriate, PCPs, specialists, and facility or vendor providers.
• Provide transitional care management.
• Meet regularly with designated partners about plan-identified members and help address barriers so the ACDE Care Coordinator can provide high-quality care management services.
• Participate in regularly scheduled meetings as needed.

Benefits

• Flexible work solutions, including remote options and hybrid work schedules.
• Competitive pay.
• Paid time off, including holidays and volunteer events.
• Health insurance coverage for associates and their dependents beginning on Day 1.
• 401(k).
• Tuition reimbursement.
• Reimbursement may be submitted by fully remote associates residing in states where service is required by contract, law, or regulation.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed