AmeriHealth Caritas Care Manager II, Urgent Response Team, Registered Nurse in Philadelphia, Pennsylvania
Care Manager II, Urgent Response Team, Registered Nurse
Location: Philadelphia, PA
Assumes the overall accountability for the identification of members/consumers (M/C) appropriate for care coordination and/or case management program services
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 .
The Care Manager assumes the overall accountability for the identification of members/consumers (M/C) appropriate for care coordination and/or case management program services. The Case Management/Care Coordination (MC/CC) program is a blended model that provides comprehensive case management and disease management services to the highest risk health plan M/C’s. Completes a comprehensive case management assessment and gathers pertinent information about the M/C’s needs by interviewing the M/C, appropriate family members, physicians, ancillary health professionals and others as necessary. Serves as an advocate for the member and acts as a liaison between the M/C and other community based agencies, facilities, providers and practitioners in coordinating the M/C’s care. Refers M/C as appropriate for other services such as Special Needs and Pharmacy. Understands, supports and practices within the scope of the appropriate Nurse Practice Act and the Case Management Practice Standards established by the Case management Society of America. This position receives no direct or indirect incentive for determinations made in applying utilization and case management guidelines in selecting providers for services or in the assignment of M/C. benefits. The Care manager may focus on the care management of a specific member health population, such as Special Needs, Pediatric, Complex, Maternity, Opioid Management, etc.
Current and unrestricted Pennsylvania Registered Nurse licensure required.
3-5 years of experience with both pediatrics and adults (physical health disorders) within an acute care setting.
Behavioral Health experience, including substance use disorder.
1-3 years' case management experience, preferably within a managed care organization.
Demonstrated proficiency working within a Windows based environment and utilizing Internet applications.
Working knowledge of MS Office, including Outlook, Word, and Excel.
Proficiency utilizing electronic medical record and documentation programs.
EOE Minorities/Females/Protected Veterans/Disabled