Job Description

Job Brief

This position is a telephonic Care Manager that is required to reside in the state of South Carolina - Counties preferred are York, Florence, Darlington, Williamsburg and Horry. RN required.

Remote to qualified candidates living in South Carolina with a preference of York, Florence, Williamsburg, Darlington and Horry counties.

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are 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 would like to connect with 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.

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Responsibilities:

As a Care Manager II, you’ll be empowered to lead the charge in improving health outcomes. You’ll monitor and update care plans based on real-time feedback from members and caregivers, continuously refining your approach to ensure it meets their evolving needs. Your role will involve close collaboration with other healthcare professionals, making you a vital link in the chain of care that keeps members on the path to health. Your contributions will also be recognized and valued within a supportive workplace culture that prioritizes collaboration, learning, and professional growth. You’ll share your clinical knowledge and expertise with your peers, helping to elevate the standard of care across the board. To excel in this role, you’ll need a Bachelor of Science in Nursing (BSN) and an unrestricted RN license in South Carolina (or a compact state) . Your background in pediatric home care or acute care will give you the experience needed to manage the unique challenges of this position. If you’ve worked within the Foster Care System, Department of Social Services, or Department of Juvenile Justice, you’ll have a distinct advantage in understanding the complex needs of some of our most vulnerable members. And of course, you’ll need to be comfortable navigating the digital landscape, with proficiency in MS Office and electronic medical records, ensuring that all member interactions are documented accurately and efficiently. Are you ready to take on a role where your nursing expertise and passion for helping others can truly shine? Step into the Care Manager II position and make a difference in the lives of those who need it most. This isn’t just a job—it’s a calling to be the compassionate guide and relentless advocate that every member deserves.

Position Overview:

1. Support Members during transitions of care through assessment, coordination of care, education of the discharge plan of care, referrals, and evaluation of the effectiveness of the plan. 
2. Review medication list and educate Members with pharmacy needs, and counsel on side effects and mitigation strategies for specific treatment protocols.
3. Evaluate, monitor, and update the care plan through regularly scheduled follow-up contacts based on the Member/caregiver progress, needs and preferences.
4. Establishes points of contact in order to collaborate with identified community, medical, and/or behavioral health teams.
5. Maintain timely, complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable.
6. Monitor appropriate utilization and coordinate services with other payer sources, make appropriate referrals, identify and escalate quality of care issues.
7. Develop a working knowledge of ACFC electronic care management platforms, care management programs, policies, standard operating procedures, workflows, Member insurance products and benefits, community resources and programs, and applicable regulatory, state, and NCQA requirements.
8. May identify cases to be presented at care management rounds and follows up with providers on recommendations to achieve optimal outcomes for Members.
9. Support a positive workplace environment, collaborate, and share clinical knowledge and skills to support our culturally and demographically diverse Member population.
10. Face-to-face visits may be required at the Member’s residence, provider’s office, hospitals, other acute location or community location for education and/or assessment.
11. Other duties as assigned.

Education Overview:

• • This is a community facing role and candidates must live in the state of South Carolina.
  • Bachelor of Science in Nursing (BSN) is required and must hold a current and unrestricted Registered Nurse (RN) license in good standing in South Carolina or a compact state.
  • A minimum of 3 years of professional experience in pediatric home care or acute care is required.
  • Prior experience in the Foster Care System, Department of Social Services, or Department of Juvenile Justice as an RN is preferred.
  • M ust engage directly with identified members through face-to-face visits in the community as needed.
  • At least 3 years of case management experience is preferred.
  • Proficiency in MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record/documentation systems is essential.
  • A valid driver’s license with car insurance is required.

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.

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