Care Manager - Maternity

Amerihealth Caritas•North Charleston, SC

14d•Remote

About The Position

Responsible for managing and coordinating care, services, and social determinants of health for Members with acute, chronic, medically complex, and behavioral health conditions and other health needs. Serves as the primary point of contact for the care team that includes Members, physicians as well as community supports to guide members in achieving their optimal level of health. Utilizes strong assessment and communication skills, critical thinking, and clinical knowledge to identify issues, gaps in care and barriers to care. The Care Manager II develops a plan of care through shared decision making with the Member/caregiver and in collaboration with providers and other care team members to improve the Member’s health status, compliance with treatment plans and promote self-management.

Requirements

South Carolina resident
BSN RN license
Minimum of 3 years of professional experience in related field required (i.e., maternal health, labor and delivery, obstetrics, etc.)
Must engage directly with identified members through face-to-face visits in the community as needed
Proficiency in MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record/documentation systems is essential
Must hold a current and unrestricted BSN Registered Nurse (RN) license in good standing in South Carolina or a compact state
Access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required.

Nice To Haves

At least 3 years of case management experience is preferred

Responsibilities

Support Members during transitions of care through assessment, coordination of care, education of the discharge plan of care, referrals, and evaluation of the effectiveness of the plan
Review medication list and educate Members with pharmacy needs, and counsel on side effects and mitigation strategies for specific treatment protocols
Evaluate, monitor, and update the care plan through regularly scheduled follow-up contacts based on the Member/caregiver progress, needs and preferences
Establishes points of contact in order to collaborate with identified community, medical, and/or behavioral health teams
Maintain timely, complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable
Monitor appropriate utilization and coordinate services with other payer sources, make appropriate referrals, identify and escalate quality of care issues.
Develop a working knowledge of ACFC electronic care management platforms, care management programs, policies, standard operating procedures, workflows, Member insurance products and benefits, community resources and programs, and applicable regulatory, state, and NCQA requirements
May identify cases to be presented at care management rounds and follows up with providers on recommendations to achieve optimal outcomes for Members
Support a positive workplace environment, collaborate, and share clinical knowledge and skills to support our culturally and demographically diverse Member population
Face-to-face visits may be required at the Member’s residence, provider’s office, hospitals, behavioral health facilities, and other acute location or community location for education and/or assessment.