Care Manager II (RN/SW) - HIDE D-SNP

Amerihealth Caritas•Columbia, SC

5d•Remote

About The Position

The Care Manager II (RN/SW) provides remote care management and care coordination for members enrolled in a Highly Integrated Dual Eligible Special Needs Plan (HIDE D-SNP). This role serves as the primary point of contact for assigned members, supporting complex medical, behavioral health, and social needs through assessment, care planning, member engagement, and coordination of services. The ideal candidate has experience managing complex Medicare and Medicaid populations, strong clinical judgment, and the ability to build member relationships in a remote environment.

Requirements

Current, unrestricted South Carolina license in good standing as a Registered Nurse (RN), Licensed Independent Social Worker-Clinical Practice (LISW-CP), Licensed Master Social Worker (LMSW), or Licensed Professional Counselor (LPC).
Associate's degree in Nursing, Master's degree in Social Work, Counseling, or related healthcare field.
Minimum 3 years of clinical, case management, care coordination, or managed care experience.
Experience working with adults with chronic and complex medical conditions.
Strong computer skills, including Microsoft Office and electronic documentation systems.
Knowledge of Medicare, Medicaid, and dual-eligible populations.
Strong assessment, critical thinking, and care coordination skills.
Excellent communication and member engagement abilities.
Experience addressing behavioral health and social determinants of health.
Ability to manage multiple priorities in a remote work environment.
Commitment to delivering high-quality, member-centered care.

Nice To Haves

BSN
Medicare, Medicaid, D-SNP, HIDE D-SNP, LTSS, or managed care experience
Remote care management experience
Knowledge of South Carolina Medicaid programs, waiver services, and community resources
CCM or other care management certification

Responsibilities

Conduct comprehensive member assessments to identify medical, behavioral, and social needs.
Develop and maintain individualized, person-centered care plans.
Coordinate care across providers, behavioral health services, community resources, and support programs.
Address social determinants of health, including housing, transportation, food security, and caregiver needs.
Perform medication reconciliation and support medication adherence.
Provide transitional care management following hospital, emergency department, or skilled nursing facility admissions.
Engage members through ongoing outreach, education, and health coaching.
Collaborate with interdisciplinary care teams to improve member outcomes.
Maintain accurate documentation and comply with CMS, NCQA, Medicare, Medicaid, and organizational requirements.
Manage an assigned caseload while meeting quality and productivity expectations.