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. 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 .
Community Care Manager Sr
Location
United States
Posted
2 days ago
Salary
0
Seniority
Lead
No structured requirement data.
Job Description
Community Care Manager Sr
Amerihealth Caritas
Role Description The Senior Community Care Manager supports members in community-based care coordination and case management programs while collaborating across the Medical Management department to ensure alignment with organizational initiatives and strategic goals. Work Arrangements: Remote – Associate must reside in the state of Michigan (MI) Responsibilities: - Serves as a single point of contact for member questions in collaboration with telephonic care managers and the Community Care Management Team (CCMT) - Conducts in-home environmental and physical assessments for high-risk members to identify unmet needs and barriers to care - Develops and maintains individualized care plans, ensuring they are regularly reviewed and updated - Provides disease self-management education and coaching within the scope of practice - Performs medication reviews, including reconciliation during transitions of care - Coordinates care across settings to ensure services are delivered in the least restrictive environment and supports transitions between care levels - Connects members to community, medical, and behavioral health resources to address barriers and support independent living - Collaborates with and oversees Community Care Navigators to facilitate access to in-community support services - Serves as a subject matter expert and supports leadership with operational activities, including training, mentoring, workflow coordination, referral review, and case assignment - Maintains a caseload and provides coverage for team members as needed to ensure continuity of care - Acts as a clinical and operational resource to address member needs and resolve complex issues - Ensures compliance with workflows, documentation standards, and regulatory requirements, including National Committee for Quality Assurance (NCQA) and Utilization Review Accreditation Commission (URAC) standards Qualifications - Bachelor’s degree in nursing required. - Current, active, and unrestricted Registered Nurse (RN) licensure in MI. - 3 plus years of case management experience. - 1 year of community care management experience. - Home Health RN experience preferred. - Certification as a Case Manager within 2 years of hire. Requirements - Current, active, and unrestricted Registered Nurse (RN) licensure in MI. - Valid driver’s license with car insurance. Skills & Abilities - Strong clinical assessment skills with the ability to evaluate member needs and identify barriers to care - Strong communication and interpersonal skills, with the ability to engage members and collaborate with interdisciplinary teams - Ability to educate and coach members on disease management and self-care strategies - Critical thinking and problem-solving skills to address complex member needs and resolve care issues - Strong organizational and time management skills - Ability to collaborate with and provide guidance to team members - Knowledge of healthcare regulations, accreditation standards, and compliance - Proficiency with documentation systems, care management platforms, and Microsoft Office tools
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