Job Description
Job Description
**Job Title: Care Manager II (Remote)**
**Job Brief**
We are seeking a qualified and licensed BSN/RN living in South Carolina with prior experience in the Foster Care System, Department of Social Services, or Department of Juvenile Justice. This role involves direct engagement with members through face-to-face visits in the community.
**Your Career Starts Now**
We are looking for the next generation of healthcare leaders. Join a team 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.
**About Us**
Headquartered in Newtown Square, Pennsylvania, we are a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management, specialty pharmacy services, behavioral health services, and other administrative services.
**Responsibilities**
As a Care Manager II, you'll be empowered to lead the charge in improving health outcomes. Your role will involve:
- Monitoring and updating care plans based on real-time feedback from members and caregivers.
- Collaborating closely with other healthcare professionals to ensure members stay on the path to health.
- Sharing your clinical knowledge and expertise with peers to elevate the standard of care.
- Supporting members during transitions of care through assessment, coordination, education, referrals, and evaluation.
- Reviewing medication lists, educating members on pharmacy needs, and counseling on side effects and mitigation strategies.
- Evaluating, monitoring, and updating care plans through regularly scheduled follow-up contacts.
- Establishing points of contact to collaborate with identified community, medical, and behavioral health teams.
- Maintaining timely, complete, and accurate documentation of member interactions in electronic care management platforms.
- Monitoring appropriate utilization and coordinating services with other payer sources.
- Developing a working knowledge of care management programs, policies, standard operating procedures, workflows, member insurance products and benefits, community resources and programs, and applicable regulatory, state, and NCQA requirements.
- Identifying cases to be presented at care management rounds and following up with providers on recommendations to achieve optimal outcomes.
- Supporting a positive workplace environment, collaborating, and sharing clinical knowledge and skills to support our culturally and demographically diverse member population.
- Conducting face-to-face visits at the member's residence, provider's office, hospitals, or other community locations for education and/or assessment.
**Education and Experience**
- Bachelor of Science in Nursing (BSN) required.
- Current and unrestricted Registered Nurse (RN) license in good standing in South Carolina or a compact state.
- A minimum of 3 years of professional experience in pediatric home care or acute care.
- Prior experience in the Foster Care System, Department of Social Services, or Department of Juvenile Justice as an RN is preferred.
- At least 3 years of case management experience is preferred.
- Proficiency in MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record/documentation systems is essential.
- A valid driver's license with car insurance is required.
**Diversity, Equity, and Inclusion**
We are committed to creating an inclusive workplace where everyone feels 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. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
**Our Comprehensive Benefits Package**
- Flexible work solutions including remote options and 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) and tuition reimbursement.
**Join Us**
If you want to make a difference, we would like to connect with you. Together, we can build healthier communities.
Employment Type: Full-Time
Salary: $ 60,000.00 95,000.00 Per Year
Job Tags
Holiday work, Full time, Remote job, Flexible hours,