Care Manager II, Complex Case Management, RN or LICSW

AmeriHealth Caritas

Washington, DC 20080

Posted 1 month ago

Job Description

**Care Manager II, Complex Case Management, RN or LICSW**


Location: Washington, DC


Primary Job Function: Medical Management


ID**: 21187


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 .


*** **Now offering a 5K Sign On Bonus*****


*****100% VIRTUAL POSITION*****


**Responsibilities:**


The Care Manager assists members appropriate for care coordination and case management services in achieving their optimal level of health. The Care Manager is responsible for engaging the member 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. Assess members to determine care coordination and case management needs for all referred members.


+ Completes comprehensive assessment of environmental, Psycho-social and 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, makes appropriate referrals and in-person visits to members when needed.


+ Implements actions to address member issues. Documents progress towards meeting goals and resolving problems.


+ Coordinates care and services with the Account manager, Complex RN Case Manager, and member, family members as appropriate, PCP, Specialist, and Facility/Vendor Providers.


+ Responsible for designing and administering programs of Care Coordination (as this is defined in Section C.10.3 and C.1.3.26) and case management for patients with multiple and complex physical, mental, and/or substance abuse conditions and treatment needs.


+ The Care Manager shall oversee the provision of a range of services and benefits covered under Sections C.8 and C.10 and in accordance with Section C.9 from multiple network Providers, as well as have knowledge of, and the ability to coordinate Covered Services with medical, educational, social, and other services and benefits that are available through other health, educational, and social services available in the District.


**Education/Experience:**


+ Active licensure as a Registered Nurse (RN) **OR** Licensed IndependentSocial Worker (LICSW) in the District of Columbia required.


+ Bachelor's degree (or higher) in Nursing or Social Work.


+ 2+ years of clinical experience working with adults and pediatrics (physical and behavioral health)


+ Certification as a case manager (as documented and accepted on URAC’s website@ www.urac.org); or LICSW licensure and three (3) years professional clinical practice experience


+ 2+ years of clinical experience working with adults and pediatrics (physical and behavioral health)


+ 2-3 years of care coordination experience preferred.


+ Valid driver’s license with car insurance.


+ Located in the District of Columbia (DC), under the leadership of a Manager with an RN, LICSW or MD licensure in DC.


EOE Minorities/Females/Protected Veterans/Disabled



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