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Care Manager II - Pediatric Registered Nurse

Company: Amerihealth
Location: Southfield
Posted on: September 9, 2021

Job Description:

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.

 

Job Summary Responsibilities:

Under the supervision of the Supervisor of Integrated Care Management, the Pediatric Complex Care Manager (CSHCS)  RN assists pediatric and complex members appropriate for care coordination and care management services in achieving their optimal level of health. The Pediatic Complex Care Manager RN is responsible for engaging members, their families/care givers and providers to assess, plan and establish individual member goals. Will facilitate and coordinate care for pediatric 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 pediatric members in the CSHCS (Childrens Special Health Care Services) care coordination program.
 
Job Related Responsibilities Qualifications/Knowledge/Skills/Abilities:

  • Assess members to determine care coordination and case management needs for all referred members.
  • Completes comprehensive assessment of medical , psycho-social and environmental 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.
  • Implements actions to address member needs. Documents progress towards meeting goals and resolving problems.
  • Facilitates access to entitlement programs and or community resources.
  • Monitors and documents member's on going progress.
  • Participates in the discharge planning process for hospitalized members.
  • Participates in work groups as requested.
  • Maintains confidentiality of all company, provider and member information.
  • Identifies and refers potential and actual quality issues to the quality management department.
  • Keeps up to date with case management initiatives.
  • Attends scheduled meetings.
  • Obtains necessary educational requirements to maintain professional licensure and certifications.
  • Comply with HIPAA confidentiality requirements to protect member personal identifiable health information.

Job related Skills and Experience:

  • Required current, unrestricted RN licensure in Michigan
  • Required experience in Pediatrics, NICU - preferred
  • Preferred 3-5  years of Case Management experience 
  • Strongly Preferred Children's Special Health Care Services  experience
  • Preferred certification as a case manager preferred

 

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. 

Keywords: Amerihealth, Southfield , Care Manager II - Pediatric Registered Nurse, Other , Southfield, Michigan

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