Manager, Integrated Care Management, Registered Nurse

Washington, DC
Feb 18, 2021
Feb 25, 2021
Full Time
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 Responsibilities: Under the supervision of the Director IHCM, the Manager of IHCM is responsible for the daily operations of the IHCM Department. Responsible for compliance with State and Federal laws and business plan goals. * Plans, organizes and directs the development and implementation of Case Management.Ensures staff is properly trained, oriented and provided with regular professional development.Identifies opportunities for improvement, both clinical and administrative, and assists the Director in the strategic planning processes for these functions. * Coordinates and implements the development of recommended policies and programs.Coordinates, establishes and monitors achievement of departmental goals and objectives.Responsible for achievement of assigned NCQA standard compliance and compliance with all applicable State and Federal laws, as well as achievement of assigned incented health outcomes. * Directs effectiveness of existing programs and services identifies and evaluates new programs and services to address cost effectiveness, proposed process improvements and to achieve compliance with NCQA and State incented health outcomes. * Participates in and supports the corporate Medical Management Strategy. * Develops and recommends a consolidated operating budget and submits to Director for approval.Reviews and authorizes disbursement of funds in accordance with operating procedures.Monitors monthly financial statements for areas of responsibility to determine and recommend adjustments. * Directs the coordination of positive inter and intra communication to share information regarding quality of care, member issues and cost effective services.Works across departmental lines to achieve objectives. * Creates and supports an environment that fosters teamwork, cooperation, respect and diversity.Establishes and maintains positive communication and professional demeanor with ACFC associates, providers and acts as liaison with outside entities as required.Demonstrates and supports commitment to corporate goals and mission. * Performs other related duties and projects as assigned. Education/ Experience: * Potential to be a virtual position. * Bachelor's Degree required; Bachelor's Degree in Nursing (BSN) preferred. * Current and unrestricted Registered Nurse licensure in the District of Columbia, preferred. * In lieu of aforementioned Registered Nurse qualfiications, candidates may also possess Master's of Social Work, three years of professional practice experience, and current and unrestricted License Social Work (LSW). * 8-10 years progressive experience in healthcare delivery required with at least; five years of experience in managed health care. * Minimum of five years of managerial experience required. Minimum of one year of project management experience required, preferably at management level. * Two years of managed Medicare experience preferred. * One year of managed Medicaid experience preferred. Back Share * * * * * Apply Now

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