Job Description: 

As part of the care coordination team, the Resource Coordinator develops and executes outreach strategies within a designated territory to improve health outcomes and enhance member engagement. This role serves as a single point of contact and advocate for members identified as low-risk who have opted out of care coordination but require additional monitoring. The position fosters relationships with members, community stakeholders, and providers.

Responsibilities:

• Provide support to low-risk maternity members following emergency department visits and/or acute care episodes involving services such as hospital inpatient stays and postpartum care.
• Assist with appointment scheduling, referrals, linkages to services, coordination of durable medical equipment (DME), referrals to wellness programs, and prior authorization coordination to ensure timely access to community services.
• Collaborate with members and/or providers to develop appropriate discharge plans.
• Address social determinants of health and close care gaps through appointment assistance, transportation coordination, connection to community resources, provider collaboration, and wellness programs.
• Conduct telephone or virtual assessments to determine care coordination needs and interventions for referred members; complete relevant assessments and screenings.
• Schedule follow-up calls, make referrals, and implement actions to resolve member issues.
• Exercise judgment and discretion in coordinating care, handling follow-up tasks, and collaborating with AmeriHealth Caritas care coordination teams, community-based providers, and other organizations.
• Inform members of required actions to meet HEDIS, EPSDT, and Plan requirements through phone calls or home visits, and encourage compliance.
• Help address barriers to care and foster relationships between members and their medical/dental providers.
• Complete additional task-based assignments as directed by leadership.

Education & Qualifications:

• Associate’s degree in healthcare, human services, or a related field, or equivalent work experience. An active Licensed Practical Nurse (LPN) license may substitute for the required education.
• 3–5 years of experience in maternity care, human services, or community programs.
• Knowledge of medical terminology and disease processes.
• Ability to effectively communicate preventive health and health management philosophies to members and agencies.
• Comprehensive understanding of Medicaid requirements, plan policies, and procedures.
• Familiarity with managed care principles.

Our Comprehensive Benefits Package:
Flexible work solutions, including remote options and hybrid schedules; competitive pay; paid time off (including holidays and volunteer events); health insurance coverage for you and your dependents starting day one; 401(k); tuition reimbursement; and more. 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 millions of lives through our national footprint of products, services, and award-winning programs.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience delivering comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management, specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.