What are the responsibilities and job description for the Community Care Manager, Pediatric Shift Care, Registered Nurse position at AmeriHealth Caritas Health Plan?
The Community Care Manager, Shift Care assists members appropriate for care coordination and case management services in achieving their optimal level of health. The selected candidate will 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. The position will function an advocate for members in the care coordination program. Assess members to determine care coordination and case management needs for all referred members. Conducts in-home physical, psycho-social, and environmental assessments and for complex pediatric members to identify unmet needs, barriers to care, and social determinants of health. Identifies barriers for care coordination and appropriate care management interventions for pediatric members requiring home care services. Creates a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health. Identifies both short and long term goals and associated time frames for completion. Shares goals with the member and family as appropriate. Identifies and implements the appropriate level of intervention based upon the member’s needs. Schedules follow up calls/visits as necessary, makes appropriate referrals. Implements actions to address member issues. Documents progress towards meeting goals and resolving problems. Coordinates care and services with the member, other family members as appropriate, Pediatric Shift Care team members, Account manager, PCP, Specialist, Facility/Vendor Providers, and community partners.
Education/Experience:
- Ability to travel extensively within assigned communities in Philadelphia and Delaware counties in Pennsylvania. Average number of visits to members in their homes is 2-5 daily.
- Current and unrestricted Pennsylvania Registered Nurse license. Bachelor's degree preferred.
- Minimum of 3 years of clinical pediatric experience in acute care and/or home care required.
- Minimum of 3 years of similar level or related experience including demonstrated expertise conducting in home physical, psycho-social, and environmental assessments for complex pediatric patients.
- 3 to 5 years of Case Management experience preferred within managed care.
- Proficient in MS Office (Word, Excel, and Outlook) within a Windows-based environment, Internet applications, electronic medical records (EMRs), and electronic documentation programs.
- Valid driver’s license required and current car insurance required.
- These positions will be remote upon successful completion of an orientation and preceptorship.
- Eligible for Certification in Case Management within one year of accepting position. Successful attainment of Case Management certification is highly recommended.
- Requires completion of medical exam/testing as required by Federal and State regulations upon conditional offer of employment and post-employment.
