Care Manager II- RN (OB experience required)

Washington, DC
Nov 09, 2018
Nov 12, 2018
Management, Nurse
Full Time
Job Brief Case Manager assumes the overall accountability for the identification of members/consumers (M/C) appropriate for care coordination and/or case management program services 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 . The Integrated Case Management program is a blended model that provides comprehensive case management and disease management services to Medicaid and Alliance members enrolled with AmeriHealth Caritas District of Columbia. Under the supervision of the Supervisor for the Bright Start Care Management Program, Care Managers (CM) provide case management and care coordination services to pregnant/postpartum individuals who meet the criteria for care management services. CMs must have the ability to provide systematic and consistent evaluation of the key elements of each assigned member's medical, psychosocial, functional, and other health care needs; to develop, implement, coordinate, monitor, and evaluate the individualized plan of care, and adhere to established timeline standards to assure member's needs are addressed according to their level of acuity and in a timely manner. The Care Manager II-OB roles, responsibilities and duties include but are not limited to: Completion of comprehensive case management assessments compliant with NCQA and DC Department of Health Care Finance standards. Development of an individualized plan of care, in collaboration with each member/caregiver, which includes long and short term goals, interventions, and barriers. member Monitor and evaluate the member/caregiver's progress towards meeting goals and initiates appropriate interventions as necessary. Conduct telephonic and face-to-face outreach to assigned members/caregivers to maintain engagement consistent with established workflows, tools and timeframes. Provide written and verbal patient education consistent with AmeriHealth Caritas DC clinical practice guidelines. Serves as an advocate for the member/caregiver and acts as a liaison between the member/caregiver and other community-based agencies, facilities, providers, and practitioners in coordinating the member's care. Refers member/caregiver, as appropriate, to address social determinants of health and other barriers to achieving health care goals. Works closely with the assigned Bright Start Care Connector to coordinate non-clinical needs, including, but not limited to, transportation, appointment scheduling and reminders, and coordinating Medicaid and value-added benefits. Monitors utilization of Medicaid and Alliance benefits for identification of over - and under-utilization patterns as well as coordinating with other payer sources, as necessary. Active participation in interdisciplinary rounds discussions through case presentation and interactive feedback to care management team members, as applicable. Understands, supports, and practices within the scope of the Case Management Practice Standards established by the Case Management Society of America (CMSA). Qualifications/Knowledge/Skills/Abilities: Required to work in the District of Columbia. Required education: Bachelors, Associate, or Diploma degree in Nursing Required to have a valid, unrestricted Registered Nurse licensure in the District of Columbia Minimum of three (3) years clinical practice experience providing OB-related nursing services Requires excellent interpersonal and organizational skills as well as strong written and verbal communication skills. Requires the ability to work independently as well as to function effectively in a team environment. Requires working knowledge of MS Office including Outlook, Word and Excel applications. Preferred experience utilizing care management platforms, or similar electronic medical record system for clinical documentation Highly Preferred: 3 to 5 years of Case Management experience Highly Preferred: successful attainment of Case Management certification

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