Care Manager II - Maternity
Amerihealth Caritas Health Plan
 Newark, DE

Responsibilities:

The Care Manager (RN/SW) will:

  • Assist members appropriate for care coordination and case management services in achieving their optimal level of health.
  • Be 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.
  • 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.
  • Complete comprehensive assessment of environmental, psycho-social and support needs.
  • Identify problems/barriers for care coordination and appropriate care management interventions.
  • Create a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health.
  • Identify both short and long term goals and associated time frames for completion.
  • Share goals with the member and family as appropriate.
  • Identify and implement the appropriate level of intervention based upon the member's needs and clinical progress.
  • Schedule follow up calls as necessary, make appropriate referrals.
  • Implement actions to address member issues.
  • Document progress towards meeting goals and resolving problems.
  • Coordinate 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:

  • A Bachelor's Degree degree in a health related field and licensure as a health professional (where such licensure is available), or
  • Master's Degree in a health related field and licensure as a health professional (where such licensure is available); or
  • MSW licensure and three (3) years professional practice experience
  • Registered Nurse
  • Certification as a case manager (as documented and accepted on URAC's website@ www.urac.org)
  • Three (3) to five (5) years experience in Case Management
  • Active state RN license and Valid driver's license with car insurance
  • Current unrestricted Social Worker License
  • Maternity, labor and deliver experience preferred.