Care Manager II, Medicare, RN/LICSW/LSW

Company: Amerihealth Caritas Health Plan
Location: Charleston
Posted on: June 24, 2022

Job Description:

This role is eligible for a $2,500 sign-on bonus for external candidates

Responsibilities:

The Care Manager (RN/SW) assists members appropriate for care coordination and case management services in achieving their optimal level of health. The Care Manager (RN/SW) is responsible for engaging the member 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 coordination program. Assess members to determine care coordination and case management needs for all referred members. Completes comprehensive assessment of environmental, Psycho-social and support needs. 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 both short and long term goals and 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 Account manager, Complex RN Case Manager, and member, family members as appropriate, PCP, Specialist, and Facility/Vendor Providers.

* The Care Manager (RN/SW) assists members appropriate for care coordination and case management services in achieving their optimal level of health.
* The Care Manager (RN/SW) is responsible for engaging the member 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 coordination program.
* Assess members to determine care coordination and case management needs for all referred members.
* Completes comprehensive assessment of environmental, Psycho-social and support needs.
* 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 both short and long term goals and 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 Account manager, Complex RN Case Manager, and member, family members as appropriate, PCP, Specialist, and Facility/Vendor Providers.

Education/Experience:

* This role is a remote role that will require in person meetings with our members. Qualified candidates must reside in South Carolina.
* A Bachelor's (or higher) degree in a health related field and licensure as a health professional (where such licensure is available)
* Graduate of accredited RN program and current and unrestricted Registered Nurse licensure in South Carolina OR MSW with current and unrestricted LICSW/LSW licensure in South Carolina and three (3) years professional practice experience
* 3-5 years Case Management experience preferred
* Certification as a case manager (as documented and accepted on URAC's website@ www.urac.org)
* Valid driver's license with car insurance

Keywords: Amerihealth Caritas Health Plan, Charleston , Care Manager II, Medicare, RN/LICSW/LSW, Healthcare , Charleston, South Carolina