Triage Care Manager

Triage Care Manager

Under the supervision of the Manager of the Care Management Department, the Triage Care Manager is responsible for assisting Participants in coordinating care for Long Term Services & Supports and closing care gaps. The Triage Care Manager will assist with Cases referred to the Special Needs Unit and complex cases referred by Service Coordination, Utilization Management, or various other sources. Additionally, the Triage Care Manager will practice case management within the scope of their licensure for our Emergency Room Diversion cases (based on the standards of the discipline).

Work Arrangement: Remote with availability to work Eastern Standard Time 8:30am-5:00pm

Additional Triage Care Manager responsibilities:

• Monitors various alerts regarding Participant resource utilization
• Monitors the utilization of assigned participants over a time-limited period
• Conducts assessments or surveys to identify problems/barriers for care coordination and appropriate intervention, including Participant education
• Identifies and implements actions to address Participant issues
• Collaborates with Medicare Care Managers from various MCOs to effectively coordinate care
• Collaborates with nursing facilities and other providers of care to coordinate care
• Notifies assigned Service Coordinators of service utilization and related care coordination
• Makes referrals and appropriate follow-ups

Education:

• Bachelor's Degree in Nursing or health related field preferred.
• Current and unrestricted Registered Nurse licensure in Pennsylvania or an Unrestricted Compact License.
• Social Worker with an unrestricted Pennsylvania clinical license.

Experience:

• Registered Nurse, or Social Worker, graduated from an accredited Diploma from a Master's Degree program.
• Minimum of 3 years of nursing experience, in a related clinical setting with Discharge Planning.
• Required Managed Care experience.
• Case Management experience preferred.
• Required Acute Discharge Planning or Skill Nursing Facility experience.
• Proficiency with Microsoft Office Suite (Word, Excel, Power Point).

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.

Your career starts now. We're looking for the next generation of health care 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 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'd like to hear from 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.