Remote Behavioral Health Utilization Review Jobs in Delaware

Role Overview:

The 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 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: Fully Remote with required weekly travel within Kent and Sussex counties.
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 within EMR system.
• Coordinates care and services with the Community Health Navigator and 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.
  

Education/Experience:

• Minimum of 3 to 5 years experience with the behavioral health population required.
• Experience working with individuals with Intellectual Developmental Disabilities population preferred
• Knowledge of Life Span Wavier program preferred
• Ability to work with specific care teams and other engagement community partners preferred.
• Case management experience, preferably within a managed care organization, is desired.
• Proficient with various technologies including Microsoft Tools and Medical Record systems.
  

Licensure:

• Current, unrestricted DE RN license in good standing or unrestricted DE LMSW / LCSW license with experience in managing medical complexities.
• Valid Driver's License.
  

Skills & Abilities:

• Demonstrate ability to be self-directed, independent, adaptive, flexible to change, and able to collaborate as a team member in a fast-paced, ever-changing environment.
• Demonstrate awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population.
• Proficiency using MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record and documentation programs.
• Demonstrate strong organizational and time management skills with the ability to promptly prioritize and follow through on multiple items.
• Demonstrate knowledge and experience in assessing members' situations, developing a care plan, and teaching self-management
  

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.

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

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 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.