Your career starts now. We are looking for the next generation of health care leaders.
At AmeriHealth Caritas, we are 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 would like to connect with 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.
Responsibilities:
- Assist members eligible for LTSS in obtaining services as required by DSHP Plus LTSS in New Castle county.
- Perform telephonic and/or face-to-face assessments for the identification, evaluation, coordination, and management of members’ needs, including physical health, behavioral health, social services, and long-term services and supports.
- Complete Level of Care Redeterminations for home and community-based members annually, requiring clinical review.
- Provide clinical support to non-licensed counterparts and may act as a secondary case manager during acute episodes.
- Conduct reevaluation of level of care annually or more frequently as needed in accordance with DSHP Plan Plus LTSS requirements.
- Provide clinical support to non-licensed case managers as needed.
- Conduct condition-specific assessments with members with chronic conditions, providing education and routine follow-up.
- Perform initial clinical assessment of new members, develop care plan, and initiate services.
- Facilitate person-centered planning team meetings to coordinate care and services.
- Identify, coordinate, and assist participants in gaining access to needed LTSS and other Covered Services.
- Provide information to participants and conduct monitoring of authorized services and supports for participants.
- Inform participants about available LTSS required needs assessments, the care plan process, service alternatives, and service delivery options.
- Inform participants of their rights and responsibilities and assist with the complaint, grievance, and DHS Fair Hearing process.
- Collect additional necessary information, including participant preferences, strengths, and goals to inform the development of the Plan of Care.
- Conduct comprehensive needs assessments annually or more frequently as needed in accordance with requirements.
- Review and act upon worklists in Jiva, including monitoring of new members.
- Authorize urgent services when needed.
- Monitor critical incident reporting/documentation, recommending/taking action with other corporate entities as required.
- Engage in liaison activities with Physical health Care Coordination program.
Education/Experience:
- Delaware licensed RN or LCSW.
- Valid driver’s license required.
- At least 3 years working in social service or health care related field.
- Experience working with people with disabilities or seniors in need of LTSS.
- Knowledge of the home and community-based service system and how to access and arrange for services.
- Experience conducting LTSS needs assessments and monitoring LTSS delivery.
- Ability to provide informed advocacy.
- Ability to interact with health care professionals in a professional manner.
- Ability to travel up to 75%.
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.
We keep our associates happy so they can focus on keeping our members healthy.
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.
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