Manager, Integrated Care Management, Medicare, RN/LMSW
Posted on: October 9, 2021
Your career starts now. We’re looking for the next generation of
health care leaders.
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 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’d like to hear
Headquartered in Philadelphia, 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 www.amerihealthcaritas.com.
This role is eligible for a $5,000
Under the supervision of the Director IHCM, the Manager of IHCM
is responsible for the daily operations of the IHCM
Department. Responsible for compliance with State and Federal laws
and business plan goals.
Plans, organizes and directs the development and implementation
of Case Management. Ensures staff is properly trained,
oriented and provided with regular professional development.
Identifies opportunities for improvement, both clinical and
administrative, and assists the Director in the strategic planning
processes for these functions.
Coordinates and implements the development of recommended
policies and programs. Coordinates, establishes and monitors
achievement of departmental goals and objectives. Responsible
for achievement of assigned NCQA standard compliance and compliance
with all applicable State and Federal laws, as well as achievement
of assigned incented health outcomes.
Directs effectiveness of existing programs and services,
identifies and evaluates new programs and services to address cost
effectiveness, proposed process improvements and to achieve
compliance with NCQA, CMS and State incented health outcomes.
Participates in and supports the corporate Population Health
Directs the case management activities to be in compliance with
the VIP Medicare Model for case management.
Directs the coordination of positive inter and intra
communication to share information regarding quality of care,
member issues and cost effective services. Works across
departmental lines to achieve objectives.
Creates and supports an environment that fosters teamwork,
cooperation, respect and diversity. Establishes and maintains
positive communication and professional demeanor with AMFC
employees, providers and acts as liaison with outside entities as
required. Demonstrates and supports commitment to corporate
goals and mission.
Performs other related duties and projects as assigned.
Bachelor’s Degree in Nursing or other health related field
Current and unrestricted Registered Nurse license in South
Carolina strongly preferred
MSW and current and unrestricted LICSW/LSW in South
Carolina (in lieu of RN license).
3 years professional practice experience.
8-10 years progressive experience in the delivery of a
health services program with 5 years of experience within a managed
5 years managerial experience.
Minimum of 1 year of project management experience required,
preferably at a management level.
Care management experience in a clinical managed care
environment, preferably within a Medicare business unit.
Time management, critical/creative thinking, communication, and
Ability to work independently and collaboratively with
Demonstrated ability to manage a caseload in a
fast-paced environment while building and enhancing team
Demonstrated professionalism and leadership skills along with
the ability to develop, direct, and support staff.
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