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 : Remote- Must reside in PA or have a compact RN licensure with PA.

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

Pediatric experience and managing chronic conditions experience preferred

Home health nursing experience preferred

Licensure

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

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, 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.

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.

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.