Pediatric Care Manager

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AmeriHealth Caritas Delaware seeks a passionate and dedicated Pediatric Care Manager to join our mission-driven team. In this vital role, you will support members and families by coordinating care, advocating for services, and promoting whole-person wellness. If you are committed to improving the lives of individuals and families across Delaware and thrive in a collaborative environment where your work makes a difference, we encourage you to apply.

Role Overview :

The Pediatric Care Manager (RN / SW) assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager (RN / SW) engages pediatric members, member caregivers, 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. In addition, the Care Manager will oversee these same care management activities within assigned practices to ensure the ACDE delivers high-quality care management services following Plan, NCQA, Federal / State standards and requirements.

Work Arrangement : Remote with required travel in Sussex County, Delaware

Responsibilities :

• Assess members through face-to-face encounters and 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 and makes appropriate referrals. Implements actions to address member issues. Documents progress towards meeting goals and resolving problems.
• Coordinates care and services with the member, member caregiver as appropriate, PCP, Specialist, and Facility / Vendor Providers
• Provides transitional care management. Meets regularly with designated partners regarding plan-identified members for care management, assists with reducing / resolving problems and or barriers so that the ACDE Care Coordinator may provide members with high-quality care management services
• Participate in regularly scheduled meetings as needed.

Experience

Licensure

Skills & Abilities

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 www.amerihealthcaritas.com.

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.