Complex Case Manager

Role Overview

The Care Manager (Registered Nurse/Licensed Independent Clinical Social Worker) assists members with complex medical needs appropriate for care coordination and case management services in achieving their optimal level of health through self-management. The Care Manager II (RN/LICSW) 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 the 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.

$5,000.00 Sign On Bonus

Work Arrangement

• Hybrid schedule totaling 20 hours/week at our AmeriHealth DC office located 1201 Maine Avenue, S.W., Suite 1000, 10th Floor, Washington, DC 20024
• Must meet face-to-face with members monthly in their homes, providers' offices, or hospital settings

Responsibilities:

• Assess members to determine care coordination and case management needs for all referred members. Works with both adults and children with complex medical needs
• 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 and 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 caregiver as appropriate, PCP, Specialist, and Facility/Vendor Providers
• Must reside in DC metro area

Education and Experience

• Required for RN candidates: Current and unrestricted Registered Nurse licensure in the District of Columbia. Associate's Degree in Nursing. Bachelor's Degree preferred
• Required for LICSW candidates: Current and unrestricted Licensed Independent Clinical Social Worker (LICSW) licensure in the District of Columbia and a Master's Degree in Social Work
• Minimum of 3 years of clinical practice experience as an RN or LICSW working with adults and/or pediatrics 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

Licensure

•  Current and unrestricted Registered Nurse licensure in the District of Columbia or Current and unrestricted Licensed Independent Clinical Social Worker (LICSW) licensure in the District of Columbia
• Must have a current Driver's License

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, which includes 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.

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 health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, service,s 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, Pennsylvania, 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.

Our Comprehensive Benefits Package

Flexible work solutions include remote options, hybrid work schedules, competitive pay, Paid Time Off (PTO), including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1 of employment, 401(k), tuition reimbursement, and more.

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