Community Care Manager Senior, BSN

Location: Detroit, MI

Primary Job Function: Medical Management

ID**: 34507

Job Brief

Visits members in Wayne county to include Detroit as well as Oakland county based on the members' needs. BSN req'd. 2+ yrs. clinical practice exp as a RN in Med/Surg or Behavioral Health. Case mgmt exp desired.

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:

Under the supervision of the Manager/Supervisor of the Community Care Management Team (CCMT), the Community Care Manager Sr. assists members appropriate for care coordination and case management program services in a community setting. The Community Care Manager Sr. collaborates with all levels of the Medical Management department for appropriate integration of Community Based Medical Management programs and with other existing and planned initiatives in order to align with annual operating plan and strategic growth initiatives. In addition, the CCM Sr. is responsible for assisting the manager/supervisor in the daily operations of the department, including but not limited to, training and mentoring new and existing associates, participating in assigning and monitoring workflows, and policy development and enforcement, reviewing referrals for appropriateness, and assigning episodes as needed. Practices case management within the scope of their licensure (based on the standards of the discipline). Performs and remains knowledgeable in all workflow and timeliness requirements for all disciplines of the CCMT. Manages a portion of a standard case load per Plan needs and provides coverage for absent community care managers as directed by management, fulfilling all responsibilities of a Community Care Manager. Demonstrates ability to make recommendations impacting care assessment, access and delivery in the CCMT program, including but not limited to, appropriate communication with members, and care management/disease management. Demonstrates ability to act as a resource in addressing clinical and technical issues. Demonstrates and maintains a current knowledge of state and federal requirements, licensing and regulating agency requirements, e.g., NCQA and URAQ standards as applicable.

The CCM Sr. performs the following functions:

• Provides access to a single point of contact for member questions or inquiries in coordination with telephonic care manager and other members of CCMT;

• Conducts in-home environmental and physical assessments for high risk members to identify unmet needs and barriers to care;

• Assists in and develops an Individualized Care Plan that is periodically reviewed and updated;

• Provides disease self-management and coaching within scope of practice;

• Conducts medication review, including reconciliation during transitions of care settings (RN only);

• Ensures the provision of services in the least restrictive setting and transitions support across and between specialties and care settings; connects members to services that promote community living and help overcome any barriers to health; establishes points of contact in order to collaborate with identified community, medical and/or behavioral health teams;

• Works closely with and directs and supervises the work of the Community Care Connectors as they deliver in-community care support pathways to establish connections to appropriate services;

• May serve as a program subject matter expert and/or assist the Manager ICM with operational responsibilities.

Education/Experience:

• Qualified candidates will visit members in Wayne county to include Detroit as well as Oakland county based on the members' needs.

• Bachelor’s Degree in Nursing required.

• Current and unrestricted RN licensure in MI.

• Current BLS.

• 2+ years clinical practice experience as a Registered Nurse in Med-Surg or behavioral health.

• 3+ years of Case Management experience preferred.

• 1+ year of community care management or home care experience is preferred.

• Maintenance of necessary educational requirements to maintain professional licensure and certifications.

• Certification as a case manager documented and accepted on www.CMSA.org preferred.

• Required to maintain valid driver’s license and car insurance.

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

Flexible work solutions including remote options, hybrid work schedules, 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.

EOE Minorities/Females/Protected Veterans/Disabled