Job Description

Role Overview

The Care Manager (RN) assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager (RN) is responsible for engaging the member, member care giver and providers to assess plan and establish individual member goals. Will facilitate and coordinate care for the members while assuring quality and use of cost-effective resources. The position will function as a single point of contact and be an advocate for members in the care management program. In addition the Care Manager will oversee these same care management activities within assigned AMH Tier III/CIN practices to ensure the AMH Tier III/CIN delivers high quality care management services in accordance with Plan, NCQA, Federal/State standards and requirements.

Work Arrangement

• This position is a remote and requires community visits and residency in Richland County

Responsibilities

• Assess members through face to face encounter or by telephone to determine care coordination and care management needs for all referred members
• Completes comprehensive person centered assessment inclusive of physical health history, mental health history, social determinants of health and supportive needs
• Coordinates physical, behavioral health and social services
• Provides medication management, including regular medication reconciliation and support of medication adherence
• Identifies problems/barriers for care coordination and appropriate care management interventions
• Creates a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health
• Identifies goals and assigns priority with associated time frames for completion. Shares goals with the member and family as appropriate
• Identifies and implements the appropriate level of intervention based upon the member’s needs and clinical progress
• Schedules follow up calls as necessary, makes appropriate referrals. Implements actions to address member issues. Documents progress towards meeting goals and resolving problems
• Coordinates care and services with the Care Coordinator, Community Health Navigator, and member, member care giver as appropriate, PCP, Specialist, and Facility/Vendor Providers
• Provides transitional care management. Meets regularly with AMH/CIN regarding Plan identified members for care management, assist with reducing/resolving problems and or barriers so that the AMH/CIN may provide members with high quality care management services
• Participate in regularly scheduled meetings with the AMH/CIN including but not limited to JOC meetings as needed

Education and Experience

• BSN required;
• 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
• At least 3 years of case management experience is preferred

Licensure

• A valid driver’s license with car insurance is required
• Must hold a current and unrestricted Registered Nurse (RN) license in good standing in South Carolina or a compact state

Skills & Abilities

• Proficiency in MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record/documentation systems is essential

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare 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’d like to hear from you.

Headquartered in Newtown Square, 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.

Discover more about us at

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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