Resource Coordinator chez AmeriHealth Caritas

As part of the care coordination team, the Maternal Resource Coordinator supports developing and executing outreach strategies in a particular territory to influence health outcomes and member engagement. The position will be a single point of contact and advocate for members in the care coordination program identified as low risk who have opted out of care coordination and need additional monitoring. This position establishes and cultivates relationships with members, community stakeholders, and providers. 

Work Arrangement: 

• Remote with the potential of travel in New Castle and Kent counties. 

 Responsibilities: 

• Actively assists with low-risk maternity members following emergency department visits and/or acute care episodes involving at least one of the following services: hospital inpatient stay, and postpartum.
• Assistance shall include, but not be limited to, appointment setting, referrals and linkages to services, coordination of DME, referrals to wellness programs, and coordination of prior authorizations as needed to support the member’s timely access to community services.
• Coordinates with the member and/or provider on an appropriate discharge plan
• Assist in closing social determinants of health and care gaps through appointment assistance, coordinating transportation, connecting to community resources, provider collaboration, and wellness programs.
• Assesses members by telephone/virtual interaction to determine care coordination needs and interventions for all referred members.  Completes appropriate assessments and screenings related to their member.
• Schedules follow-up calls as necessary, makes appropriate referrals, and implements actions to address member issues.
• Exercises judgment and discretion in coordinating care by handling basic follow-up tasks and collaborating with AmeriHealth Caritas care coordination teams, community-based health care providers, and other organizations.
• Informs members of the required actions to fulfill HEDIS, EPSDT, and Plan requirements and other referred outreach through phone calls or home visits, and encourages them to comply.
• Assists in addressing members’ barriers to care and encourages/fosters relationships with their medical/dental providers (medical/dental homes).
• Completing additional task-based assignments as directed by the leadership team.

 Education & Qualifications:

• Associate’s degree in healthcare, human services, or a related field, or equivalent work experience.
• An active Licensed Practical Nurse (LPN) can be substituted for the required education.
• 3 to 5 years of experience with maternity, human services,and community programs required.
• Knowledge and understanding of medical terminology and disease processes.
• Effectively communicate preventive health and health management philosophies to members and agencies.
• Comprehensive understanding of Medicaid requirements and plan, policies, and procedures
• Knowledge of managed care.
   

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 one, 401(k) tuition reimbursement and more.

Your career starts now. We’re looking for the next generation of healthcare 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 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. 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.

Discover more about us at www.amerihealthcaritas.com.