Care Manager II, LTSS, RN/LCSW
Company: Amerihealth Caritas
Location: Asheville
Posted on: March 30, 2025
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Job Description:
Your career starts now. We're looking for the next generation of
healthcare 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 healthcare 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, 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.Discover more about us at;.;This position will require
regional travel up to 90%.;Responsibilities:The Care Manager II is
responsible for managing and coordinating care, services, and
social determinants of health for Members with acute, chronic,
medically complex and/or behavioral health conditions and other
health needs. Serves as the primary point of contact for the care
team that includes Members, physicians as well as community
supports to guide members in achieving their optimal level of
health. Utilizes strong assessment and communication skills,
critical thinking, and clinical knowledge to identify issues, gaps
in care and barriers to care. The Care Manager II develops a plan
of care through shared decision making with the Member/caregiver
and in collaboration with providers and other care team members to
improve the Member's health status, compliance with treatment plans
and promote self-management. The Care Manager II is also
responsible for the following: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.;Review medication list and educate
Members with pharmacy needs, and counsel on side effects and
mitigation strategies for specific treatment protocols.Evaluate,
monitor, and update the care plan through regularly scheduled
follow-up contacts based on the Member/caregiver progress, needs
and preferences.Establishes points of contact to collaborate with
identified community, medical, and/or behavioral health
teams.Maintain timely, complete, and accurate documentation of
Member interactions in ACFC electronic care management platforms
where applicable.Monitor appropriate utilization and coordinate
services with other payer sources, make appropriate referrals,
identify, and escalate quality of care issues.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.May identify cases to be presented at care management
rounds and follows up with providers on recommendations to achieve
optimal outcomes for Members.Support a positive workplace
environment, collaborate, and share clinical knowledge and skills
to support our culturally and demographically diverse Member
population. 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.Other duties as
assigned.Education/ExperienceQualified candidates must be local to
Asheville, NC.
Keywords: Amerihealth Caritas, Asheville , Care Manager II, LTSS, RN/LCSW, Executive , Asheville, North Carolina
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