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Care Manager II - Bright Start (RN) | Hybrid

Location: Washington, DC

Primary Job Function: Medical Management

ID**: 34315

Job Brief

This position is Hybrid requiring 3 days in the office or field in DC Metro area. The other 2 days will be remote work from home. MUST reside in DC Metro area and have active DC RN License.

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 .

Responsibilities:

The Care Manager II (RN) provides support to pregnant and postpartum members in our Bright Start program. The Care Manager II (RN) is responsible for engaging the member, member caregiver, and providers to assess, plan, and establish individual member goals. You will facilitate and coordinate care for the members throughout the pre- and post-partum period 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 throughout their pregnancy.

• Assess members to determine care coordination and case management needs for all referred members. Provides support to members throughout their pregnancy and postpartum period.

• Completes comprehensive person-centered assessment of physical health, psycho-social health, environmental, as well as social determinants of health and supportive needs.

• Identifies problems/barriers for care coordination and appropriate care management interventions.

• Coordinates physical, behavioral health and social services.

• Provides medication management, including regular medication reconciliation and support of medication adherence.

• 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 caregiver 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 Care Coordinator, Community Health Navigator, and member, member care giver as appropriate, PCP, Specialist, and Facility/Vendor Providers.

Education/ Experience :

• Qualified candidates must reside in the DC Metro area

• Active DC RN license

• A bachelors (or higher) degree in a health-related field preferred and licensure as a health professional (where such licensure is available)

• Certification as a case manager preferred (as documented and accepted on URAC’s website@ www.urac.org)

• Willing to meet face to face with members in the community, on occasion, based on business needs

• 3 to 5 years of nursing experience required, working with Medicaid populations, either in the hospital or community health setting

• Experience is OBGYN and/or Maternal Health highly preferred

• 3 to 5 years of case management experience preferred

• Bilingual English/Spanish or English/Amharic preferred

Diversity, Equity, and Inclusion

At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be 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

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.

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EOE Minorities/Females/Protected Veterans/Disabled