Pediatric Care Manager

Role Overview

The Pediatric Care Manager supports members in achieving optimal health through self-management. Engaging with members, caregivers, and providers, the role involves assessing plans, setting individual goals, and coordinating care to ensure quality and cost-effective resources. This position serves as a single point of contact and advocates for care coordination program members, overseeing care management activities within assigned practices to meet Plan, NCQA, and Federal/State standards.

Work Arrangement: Fully Remote; must reside in Pennsylvania

Responsibilities

• Conduct telephone assessments to determine care coordination and management needs

• Complete comprehensive person-centered assessments covering physical and mental health history, social determinants, and supportive needs

• Coordinate physical, behavioral health, and social services

• Manage medications, including reconciliation and adherence support

• Identify problems/barriers and implement appropriate care management interventions

• Develop care plans to help members achieve optimal health, setting goals and priorities

• Share goals with members and families as appropriate

• Implement interventions based on member needs and clinical progress

• Schedule follow-up calls and make referrals as necessary

• Document progress towards goals and problem resolution

• Coordinate care with Community Health Navigators, caregivers, PCPs, specialists, and facility/vendor providers

• Meet regularly with partners to address care management issues and ensure high-quality services

• Participate in scheduled meetings as needed

Education and Experience

• Associate Degree in Nursing required. Bachelor of Science in Nursing preferred

• 3 years of professional practice experience

• Minimum of 3 years of case management experience

• Behavioral Health and managing chronic conditions experience preferred

• Home Health or Acute Care nursing experience preferred

Licensure

• Current and unrestricted Registered Nurse licensure in PA or compact licensure with PA required

Skills & Abilities:

• Demonstrate ability to be self-directed, independent, adaptive, flexible to change, and able to collaborate as a team member in a fast-paced, ever-changing environment.

• Demonstrate awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population.

• Proficiency using MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record and documentation programs.

• Demonstrate strong organizational and time management skills with the ability to promptly prioritize and follow through on multiple items.

• Demonstrate knowledge and experience in assessing members’ situations, developing a care plan, and teaching self-management

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.

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection 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 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 Newtown Square, 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 www.amerihealthcaritas.com .

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.