Role Overview
The Care Manager II helps members achieve optimal health through self-management, advocacy, and care coordination. Acting as a single point of contact, you will engage with members, caregivers, and providers to assess needs, develop personalized care plans, and coordinate resources. This role ensures members receive quality, cost-effective services in alignment with Plan, NCQA, and Federal/State standards.
Key Responsibilities
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Conduct telephone assessments to determine care coordination and management needs.
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Complete person-centered assessments, addressing physical/mental health, social determinants, and support needs.
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Coordinate care across physical, behavioral health, and social services.
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Manage medications, including reconciliation and adherence support.
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Identify barriers and implement appropriate interventions.
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Develop and monitor individualized care plans with measurable goals.
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Communicate goals and progress with members and families.
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Schedule follow-ups, make referrals, and document care progress.
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Collaborate with caregivers, PCPs, specialists, facility providers, and Community Health Navigators.
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Participate in regular meetings to ensure service quality.
Education & Experience
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Associate Degree in Nursing required; BSN preferred.
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Minimum 3 years of professional nursing practice.
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At least 3 years of case management experience.
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Preferred: Pediatric care, chronic condition management, or home health experience.
Licensure
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Current and unrestricted RN license in PA (or compact RN license with PA).
About AmeriHealth Caritas
AmeriHealth Caritas is a mission-driven healthcare organization headquartered in Newtown Square, PA, with more than 30 years of experience delivering outcomes-driven care. We provide managed care, pharmacy benefit management, specialty pharmacy, behavioral health, and administrative services to help people live healthier lives.
Learn more at www.amerihealthcaritas.com.
Benefits We Offer
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Remote/hybrid work flexibility.
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Competitive pay with annual performance reviews.
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Health, dental, and vision coverage for employees and dependents starting Day 1.
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Paid time off, holidays, and volunteer opportunities.
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401(k) with company match.
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Tuition reimbursement and professional growth opportunities.