Job Description

Remote to qualified candidates living in South Carolina with a preference York County, Aiken County, Charleston County, Berkeley County, Dorchester County, Horry County

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are 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 would like to connect with you.

Headquartered in Newtown Square, Pennsylvania 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.

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Responsibilities:

The Care Manager II is responsible for managing and coordinating care, services, and social determinants of health for Members with acute, chronic, medically complex and/or 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. The Care Manager II is also responsible for the following:

Position Overview:

1. 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.;
2. Review medication list and educate Members with pharmacy needs, and counsel on side effects and mitigation strategies for specific treatment protocols.
3. Evaluate, monitor, and update the care plan through regularly scheduled follow-up contacts based on the Member/caregiver progress, needs and preferences.
4. Establishes points of contact in order to collaborate with identified community, medical, and/or behavioral health teams.
5. Maintain timely, complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable.
6. Monitor appropriate utilization and coordinate services with other payer sources, make appropriate referrals, identify and escalate quality of care issues.
7. 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.
8. May identify cases to be presented at care management rounds and follows up with providers on recommendations to achieve optimal outcomes for Members.
9. Support a positive workplace environment, collaborate, and share clinical knowledge and skills to support our culturally and demographically diverse Member population.
10. Face-to-face visits may be required at the Member’s residence, provider’s office, hospitals, other acute location or community location for education and/or assessment.
11. Other duties as assigned.

Education Overview:

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  • This is a community facing role and candidates must live in the state of South Carolina.
  • BSN required and must hold a current and unrestricted Registered Nurse (RN) license in good standing in South Carolina or a compact state.
  • A minimum of 3 years of professional experience in pediatric home care or acute care is required.
  • Prior experience in the Foster Care System, Department of Social Services, or Department of Juvenile Justice as an RN is preferred.
  • Must engage directly with identified members through face-to-face visits in the community as needed.
  • At least 3 years of case management experience is preferred.
  • Proficiency in MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record/documentation systems is essential.
  • A valid driver’s license with car insurance is required.

Diversity, Equity, and Inclusion

At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

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