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Manager, Integrated Care Management, Medicare, RN/LMSW

Company: Amerihealth
Location: Charleston
Posted on: October 9, 2021

Job Description:

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 from you.

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 sign-on bonus

Responsibilities:

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 Strategy. 
  • 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.

Education/ Experience:

  • Bachelor’s Degree in Nursing or other health related field required. 
  • 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 care organization.
  • 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 problem-solving skills
  • Ability to work independently and collaboratively with cross-functional teams.
  • Demonstrated ability to manage a caseload in a fast-paced environment while building and enhancing team productivity.
  • Demonstrated professionalism and leadership skills along with the ability to develop, direct, and support staff.

Keywords: Amerihealth, Charleston , Manager, Integrated Care Management, Medicare, RN/LMSW, Other , Charleston, South Carolina

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