Care Manager II, Complex Integrated, Registered Nurse

Responsibilities: 

The Care Manager (RN) assists members appropriate for care coordination and case management services in achieving their optimal level of health.  The Care Manager (RN) 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.

Education/Experience:

• Active Michigan RN license.
• 5 years nursing experience in managed care and/or hospital settings working with patients with chronic disease states (e.g. diabetes, sickle cell, asthma, etc.).
• Must have experience and be comfortable with using technology (e.g. MS Office including Outlook, Word, and Excel) and electronic medical records.
• Minimum of 3+ years of Case Management experience preferred.
• Valid driver's license and car insurance required.

.Note:  Presently all of our AmeriHealth Caritas Family of Companies associates are working remotely due to the Pandemic.   This role/department will return to the Southfield, Michigan office when it is safe.