AmeriHealth Caritas Delaware seeks a passionate and dedicated Pediatric Care Manager to join our mission-driven team. In this vital role, you will support members and families by coordinating care, advocating for services, and promoting whole-person wellness. If you are committed to improving the lives of individuals and families across Delaware and thrive in a collaborative environment where your work makes a difference, we encourage you to apply.
Role Overview
The Pediatric Care Manager (RN/SW) assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager engages pediatric members, member caregivers, and providers to assess, plan, and establish individual member goals. It facilitates and coordinates care while ensuring quality and cost‑effective resource use. The position serves as a single point of contact and advocate for members in the care coordination program and oversees these activities within assigned practices to meet plan, NCQA, federal/state standards.
Work Arrangement
Remote with required travel in New Castle County, Delaware.
Responsibilities
Assess members through face‑to‑face encounters and telephone to determine care coordination and management needs for all referred members.
Complete comprehensive person‑centered assessment, including physical health history, mental health history, social determinants of health, and supportive needs.
Coordinate physical, behavioral health, and social services.
Provide medication management, including regular medication reconciliation and support of medication adherence.
Identify problems/barriers for care coordination and appropriate care management interventions.
Create a plan of care to assist members in reducing/resolving problems or barriers so that members may achieve optimal health.
Identify goals, assign priority with time frames, and share goals with member and family as appropriate.
Implement appropriate level of intervention based on member’s needs and clinical progress.
Schedule follow‑up calls as necessary and make referrals, documenting progress toward goals.
Coordinate care and services with member, caregiver, PCP, specialists, and facility/vendor providers.
Provide transitional care management and meet with partners to support members.
Participate in regularly scheduled meetings as needed.
Experience
Minimum of 3‑5 years’ experience with the pediatric population required.
Case management experience, preferably within a managed care organization, is desired.
Licensure
Current, unrestricted DE RN license in good standing or unrestricted DE LBSW/LMSW or LCSW license with experience in managing medical complexities.
Valid Driver’s License.
Skills & Abilities
Self‑directed, independent, adaptive, and flexible; collaborative team member in fast‑paced environments.
Awareness of culturally and demographically diverse populations.
Proficiency using MS Office, internet applications, electronic medical record, and documentation programs.
Strong organizational and time‑management skills with ability to prioritize and follow‑through on multiple items.
Knowledge and experience in assessing members’ situations, developing a care plan, and teaching self‑management.
Benefits
Flexible work solutions including remote options, hybrid schedules.
Competitive pay, paid time off including holidays, volunteer events.
Health insurance coverage Day 1, 401(k), tuition reimbursement and more.