RN Maternity Case Manager (must be local to DC Metro area)

Your career starts now. We’re looking for the next generation of healthcare 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 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. 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, PA, 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. 

$5,000.00 SIGN ON BONUS

The Care Manager II assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management.  The Care Manager is responsible for engaging the member, member caregiver 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  high quality care management services are delivered in accordance with Plan, NCQA, Federal/State standards and requirements.

• Assess members 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, makes appropriate referrals. Implements actions to address member issues. 
• Documents progress towards meeting goals and resolving problems.
• Coordinates care and services with the member, member's caregiver as appropriate, PCP,  Specialist, and Facility/Vendor Providers.
• Meets regularly with designated partners regarding Plan identified members for care management, assist with reducing/resolving problems and or barriers.
• Participate in regularly scheduled meetings as needed.

Education & Experience:

• This role consists of a hybrid work schedule working 1 day remotely and 4 days a week at our AmeriHealth DC office located 1201 Maine Avenue, S.W., Suite 1000, 10th Floor, Washington, DC 20024. 
• Qualified candidates must reside in the DC Metro area.
• Current and unrestricted Registered Nurse licensure in the District of Columbia. Associate's Degree in Nursing. Bachelor's Degree preferred. 
• Minimum of 3 years of clinical practice experience as a RN working with high-risk ante and post-partum patients with complex medical and behavioral health diagnoses within an acute care, homecare or community health setting. 
• Minimum of 1 year of case management experience supporting Medicaid members within a managed care organization preferred.
• Proficiency using MS Office (Word, Excel, Teams, Outlook) in a Windows-based environment and electronic medical record and documentation programs. 
• Must be willing to meet face to face with members in their homes, providers' offices, or in a hospital setting on a monthly basis.
• Must have current Driver's license. 

• Bilingual English/Spanish or English/Amharic preferred.

  The range displayed in this job posting reflects the minimum and maximum for new hire salaries for the position in the Washington DC area. 
  Within the range, individual pay is determined by additional factors, including, without limitation, job-related skills, experience, and relevant education, certifications, or training. 
  AmeriHealth Caritas associates are eligible to participate in our annual incentive program and will also receive our benefits package, consisting of medical, vision, dental, life insurance, disability insurance, 401(k), paid time off and more. 
  The targeted hiring range for this role is expected to be between $78,600.00 and $107,100.00.
   

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable being themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

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.

#PH