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Senior Community Care Manager

AmeriHealth Caritas

Southfield, MI

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JOB DETAILS
SKILLS
Accreditation Standards, Auto Insurance, Behavioral Health, Business Strategy, Case Management, Certified Case Manager (CCM), Clinical Competency, Coaching, Communication Skills, Community Support, Customer Support/Service, Disease Prevention and Control, Diversity, Documentation, Documentation Standards, Driver's License, Environmental Impact, Health Plan, Healthcare, Home Care, Interpersonal Skills, Leadership, Maintain Compliance, Medications, Mentoring, Microsoft Office, National Committee for Quality Assurance (NCQA), Needs Assessment, Nursing, Operational Support, Organizational Skills, People Management, Problem Solving Skills, Reconciliation, Registered Nurse (RN), Regulations, Regulatory Compliance, Regulatory Requirements, Risk Analysis, Systems Administration/Management, Team Player, Time Management, Utilization Review Accreditation Commission (URAC)
LOCATION
Southfield, MI
POSTED
1 day ago
Role Overview: The Senior Community Care Manager supports members in community-based care coordination and case management programs while collaborating across the Medical Management department to ensure alignment with organizational initiatives and strategic goals.


Work Arrangements:


+ Remote – Associate must reside in Michigan (MI)


Responsibilities:


+ Serves as a single point of contact for member questions in collaboration with telephonic care managers and the Community Care Management Team (CCMT)

+ Conducts in-home environmental and physical assessments for high-risk members to identify unmet needs and barriers to care

+ Develops and maintains individualized care plans, ensuring they are regularly reviewed and updated

+ Provides disease self-management education and coaching within the scope of practice

+ Performs medication reviews, including reconciliation during transitions of care

+ Coordinates care across settings to ensure services are delivered in the least restrictive environment and supports transitions between care levels

+ Connects members to community, medical, and behavioral health resources to address barriers and support independent living

+ Collaborates with and oversees Community Care Connectors to facilitate access to in-community support services

+ Serve as a subject matter expert and supports leadership with operational activities, including training, mentoring, workflow coordination, referral review, and case assignment

+ Maintains a caseload and provides coverage for team members as needed to ensure continuity of care

+ Acts as a clinical and operational resource to address member needs and resolve complex issues

+ Ensures compliance with workflows, documentation standards, and regulatory requirements, including National Committee for Quality Assurance (NCQA) and Utilization Review Accreditation Commission (URAC) standards


Education & Experience:


+ Bachelor’s degree in nursing required.

+ Current, active, and unrestricted Registered Nurse (RN) licensure.

+ 3 plus years of case management experience.

+ 1 year of community care management experience.

+ Home Health RN experience preferred

+ Certification as a Case Manager within 2 years of hire.


Licensure:


+ Current, active, and unrestricted Registered Nurse (RN) licensure.

+ Valid driver’s license with car insurance.


Skills & Abilities:


+ Strong clinical assessment skills with the ability to evaluate member needs and identify barriers to care

+ Strong communication and interpersonal skills, with the ability to engage members and collaborate with interdisciplinary teams

+ Ability to educate and coach members on disease management and self-care strategies

+ Critical thinking and problem-solving skills to address complex member needs and resolve care issues

+ Strong organizational and time management skills

+ Ability to collaborate with and provide guidance to team members

+ Knowledge of healthcare regulations, accreditation standards, and compliance

+ Proficiency with documentation systems, care management platforms, and Microsoft Office tools
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.

About the Company

A

AmeriHealth Caritas

Leaders in health care solutions for those most in need

AmeriHealth Caritas is the nation's leader in providing comprehensive health care solutions for those in most need and the chronically ill. We impact the lives of more than 5.7 million members nationwide. With more than 30 years of experience managing care for individuals and families in publicly-funded programs, we have become known for developing innovative solutions that help improve health outcomes while reducing costs.

Our mission, our goal

Our mission is to help people get care, stay well and build healthy communities. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP - plus behavioral health, pharmacy benefits management and third-party management and administrative services.

COMPANY SIZE
5,000 to 9,999 employees
INDUSTRY
Healthcare Services
FOUNDED
1985
WEBSITE
http://www.amerihealthcaritas.com