**Care Manager II**
Location: Lafayette, LA
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 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. 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.
The case manager is accountable for providing intensive monitoring, follow-up, clinical management of high risk enrollees, and care coordination activities, which include development of the MCO plan of care, ensuring appropriate referrals and timely two-way transmission of useful enrollee information; obtaining reliable and timely information about services other than those provided by the PCP; supporting the enrollee in addressing social determinants of health; and supporting safe transitions in care for enrollees moving between institutional and community care settings. The case manager may serve on one or more multi-disciplinary care teams and is responsible for coordinating and facilitating meetings and other activities of those care teams. This position will provide face-to-face member visits when deemed appropriate by the manager/supervisor, job role or required by state contract services.
+ Bachelor's Degree.
+ Registered Nurse.
+ A bachelors (or higher) degree in a health related field and licensure as a health professional (where such licensure is available); or
+ Certification as a case manager (as documented and accepted on URAC's website@ www.urac.org); or
+ MSW licensure and three (3) years professional practice experience; and
+ Active state RN license.
+ Valid driver's license with car insurance.
+ Current unrestricted Social Worker License.
+ 3-5 years of Case Management preferred.
EOE Minorities/Females/Protected Veterans/Disabled