AmeriHealth Caritas Care Manager II in Charleston, South Carolina
Care Manager II
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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.
Under the supervision of the Supervisor of Integrated Care Management, the Prenatal Care Manager RN assists members appropriate for care coordination and care management services in achieving their optimal level of health. The Prenatal Care Manager RN is responsible for engaging the pregnant member and providers to assess, plan and establish individual member goals. Will facilitate and coordinate care for the pregnant 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 pregnant members in the Bright Start care coordination program.
Principle accountabilities are, but not limited to:
- Assess members to determine care coordination and case management needs for all referred members.
- Completes comprehensive assessment of medical , psycho-social and environmental 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.
- Implements actions to address member needs. Documents progress towards meeting goals and resolving problems.
- Facilitates access to entitlement programs and or community resources.
- Monitors and documents member's on going progress.
- Participates in the discharge planning process for hospitalized members.
- Participates in work groups as requested.
- Maintains confidentiality of all company, provider and member information.
- Identifies and refers potential and actual quality issues to the quality management department.
- Keeps up to date with case management initiatives.
- Attends scheduled meetings.
- Obtains necessary educational requirements to maintain professional licensure and certifications.
- Comply with HIPAA confidentiality requirements to protect member personal identifiable health information.
- Current and unrestricted RN in the state of SC.
- Experience in Labor and Delivery, Mother / Baby, post-partum care.
- Three – five years of Case Management experience preferred.
- Certification as a case manager preferred; obtain certification in Case Management within 2 years of accepting position.
- Valid driver’s license with car insurance.
EOE Minorities/Females/Protected Veterans/Disabled