The Maternal Care Manager (Registered Nurse /Social Worker) assists maternity members who are appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Maternal Care Manager/Coordinator (RN/SW) engages the member, caregivers, and providers to assess, plan, and establish individual member goals. They will facilitate and coordinate care for the members while assuring quality and the use of cost-effective resources. The position will function as a single point of contact and be an advocate for members in the care coordination program. In addition, the Care Manager/Coordinator will oversee these same care management activities within assigned practices to ensure the ACDE delivers high-quality care management services per Plan, NCQA, Federal/State standards and requirements.

 Work Arrangement: 

• Remote with travel required in Kent and Sussex counties. 

Responsibilities: 

• Assess members through face-to-face encounters and by telephone to determine care coordination and care management needs for all referred members.
   
• Completes comprehensive person-centered assessment including physical health history, mental health history, social determinants of health, and supportive needs.
   
• Coordinates physical, behavioral health, and social services;
   
• Provides medication management, including regular medication reconciliation and support of medication adherence;
   
• Identifies problems/barriers for care coordination and appropriate care management interventions. 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 goals and assigns priority with 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 and clinical progress.
   
• Schedules follow-up calls as necessary and makes appropriate referrals. Implements actions to address member issues. Document progress towards meeting goals and resolving problems.
   
• Coordinates care and services with the Community Health Navigator, member, member caregiver as appropriate, PCP, Specialist, and Facility/Vendor Providers.
   
• Provides transitional care management. Meets regularly with designated partners regarding plan-identified members for care management, assists with reducing/resolving problems and/or barriers so that the ACDE Care Coordinator may provide members with high-quality care management services.
   

• Participate in regularly scheduled meetings as needed. 

   

   

Education/Experience:

• A bachelor’s (or higher) degree in a health-related field and licensure as a health professional (where such licensure is available); or
  Certification as a case manager (as documented and accepted on URAC’s website@, www.urac.org); or
   
• MSW licensure and three (3) years of professional practice experience; and
   
• A Master’s degree in a health-related field and licensure as a health professional (where such licensure is available); or
   
• Certification as a case manager (as documented and accepted on URAC’s website@, www.urac.org); or 
   
• MSW licensure and three (3) years of professional practice experience; and
   
• Active Delaware RN license
   
• Valid driver’s license with car insurance
   
• Current unrestricted Social Worker License
   
• 3-5 years of Case Management experience preferred
   

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.

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, PA, 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.