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, 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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About this job:

Under the supervision of the Supervisor of Medicare LTSS Operations, the Medicare LTSS Care Coordinator must have relevant experience and education to work with members with complex health, behavioral health, long-term services, and support and psychosocial needs. The Care Coordinator is responsible for the overall management of member care coordination within the scope of licensure and by applicable CMS/State and internal requirements.

Responsibilities:

• Provide care coordination to Medicare beneficiaries receiving LTSS and custodial care.
• Responsible for performing telephonic or face-to-face clinical assessments to identify, evaluate, coordinate, and manage member’s needs, including physical health, behavioral health, social services, and long-term services and supports.
• Identifies members for high-risk complications and coordinates care in conjunction with the member and the Integrated Care Team.
• Care coordination for members with chronic illnesses, co-morbidities, and disabilities to ensure cost-effective and efficient utilization of health benefits.
• Obtains a thorough and accurate member history to develop an individual care plan.
• Establish short—and long-term goals in collaboration with the member, caregivers, family, natural supports, and physicians; identify members who would benefit from an alternative level of care or home—and community-based waiver programs.
• Responsible for developing the care plan for services for the member and ensuring the member’s access to those services.
• Assisted with implementing member care plans by facilitating authorizations/referrals for the utilization of services.
• Interfaces with the Medical Director and other Integrated Care Team participants on developing care management treatment plans.
• May also assist in problem solving with providers, claims, or service issues.
• May direct the work of other licensed and unlicensed professionals in coordinating services for a member by assigning appropriate tasks, verifying and interpreting member information obtained, and conducting additional assessments, as necessary, to develop, monitor, evaluate, and revisit the member’s care plan to meet the member’s needs.
• Maintains a current knowledge of CMS and DHHS requirements along with required licensure and required training.
• Adheres to AmeriHealth Caritas policies and procedures.
• Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity.
• Instills a work culture of continuous process improvement, innovation, and quality.
• Demonstrates and supports commitment to corporate goals and objectives.
• Performs other related duties and projects as assigned.

Education & Qualifications:

• A Licensed Registered Nurse (RN) preferred, Licensed Clinical Social Worker (LCSW), or Licensed Master Social Worker (LMSW) is required.
• Minimum of 3 years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a service coordinator, case management, or similar role or any combination of education and experience that would provide an equivalent background
• Proficient PC skills with Microsoft Office Suite (Word, Excel, etc.)
• Strong knowledge of Medicare/MMP LTSS
• Ability to communicate with beneficiaries who have medical needs and may have communication barriers, such as those who require an interpreter, including sign language, who use assistive technology to communicate.
• The ability to closely follow quality standards.
• Decision-making skills
• The position requires 50% or more local travel to complete assessments in members' homes, hospitals, or skilled facilities. ; (Mileage reimbursement is provided.)
• In-person office meetings monthly or as needed. ;
• Field experience preferred. ;
• This position is community-facing, servicing Detroit, Michigan, and Western Wayne County suburbs. ; Candidates must be located within Wayne County. ;

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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 include remote options, hybrid work schedules, competitive pay, paid time off, 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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