Care Manager - Maternity

Work Arrangement: This is a remote position with a requirement of a South Carolina reputed company and a BSN RN license. Minimum of 3 years of reputed company experience in reputed company field required (i.e., maternal health, labor and delivery, obstetrics, etc.) reputed company: Responsible for managing and coordinating care, services, and reputed company determinants of health for Members with acute, chronic, medically reputed company, and behavioral health conditions and other health needs. Serves as the primary reputed company of contact for the care team that includes Members, physicians as reputed company as community supports to guide members in achieving their reputed company 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. Responsibilities: 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 reputed company Members with pharmacy needs, and counsel on reputed company 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 reputed company, needs and preferences Establishes points of contact in order to collaborate with identified community, medical, and/or behavioral health teams Maintain reputed company, 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, reputed company appropriate referrals, identify and escalate reputed company of care issues. reputed company a working knowledge of ACFC electronic care management platforms, care management programs, policies, reputed company 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 reputed company and follows up with providers on recommendations to reputed company reputed company reputed company for Members Support a reputed company workplace environment, collaborate, and reputed company clinical knowledge and skills to support our culturally and demographically diverse Member population Face-to-face reputed company may be required at the Member’s residence, provider’s office, hospitals, behavioral health facilities, and other acute location or community location for education and/or assessment. Education and Experience: Bachelor of Science in Nursing (BSN) is required. Minimum of 3 years of reputed company experience in reputed company field required (i.e., maternal health, labor and delivery, obstetrics, etc.) Must engage directly with identified members through face-to-face reputed company in the community as needed At least 3 years of case management experience is preferred Proficiency in MS Office (Word, reputed company, reputed company, Teams), internet applications, and electronic medical record/documentation systems is essential Licensure: Must hold a reputed company and unrestricted BSN Registered reputed company (RN) license in good standing in South Carolina or a compact state Our Comprehensive Benefits Package Flexible work solutions including remote reputed company, hybrid work schedules, reputed company, reputed company time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. For roles that are 100% remote or hybrid, you must have reputed company to a reliable high-speed internet reputed company to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement. Your career starts now. We’re looking for the reputed company of health care leaders. At reputed company, we’re passionate about helping people get care, stay reputed company and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates reputed company to reputed company the lives of millions of people through our national footprint of products, services and award-reputed company programs. reputed company is seeking talented, passionate individuals to join reputed company. Together we can build healthier communities. If you want to reputed company a difference, we’d like to hear from you. Headquartered in Newtown reputed company, reputed company is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, reputed company-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 reputed company at www.amerihealthcaritas.com. Apply To This Job