RN Care Coordinator
Company: AmeriHealth Caritas
Location: Dublin
Posted on: July 2, 2025
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Job Description:
Role Overview: The Care Manager is responsible for managing and
coordinating care, services, and social determinants of health for
Members with acute, chronic, medically complex and/or behavioral
health conditions and other health needs. Serves as the primary
point of contact for the care team that includes Members,
physicians as well as community supports to guide members in
achieving their optimal level of health. Utilizes strong assessment
and communication skills, critical thinking, and clinical knowledge
to identify issues, gaps in care and barriers to care. The Care
Manager develops a plan of care through shared decision making with
the Member/caregiver and in collaboration with providers and other
care team members to improve the Member’s health status, compliance
with treatment plans and promote self-management. The Care Manager
is also responsible for the following: Responsibilities: Support
Members during transitions of care through assessment, coordination
of care, education of the discharge plan of care, referrals, and
evaluation of the effectiveness of the plan. Review medication list
and educate Members with pharmacy needs, and counsel on side
effects and mitigation strategies for specific treatment protocols.
Evaluate, monitor, and update the care plan through regularly
scheduled follow-up contacts based on the Member/caregiver
progress, needs and preferences. Establishes points of contact to
collaborate with identified community, medical, and/or behavioral
health teams. Maintain timely, complete, and accurate documentation
of Member interactions in ACFC electronic care management platforms
where applicable. Monitor appropriate utilization and coordinate
services with other payer sources, make appropriate referrals,
identify, and escalate quality of care issues. Develop a working
knowledge of ACFC electronic care management platforms, care
management programs, policies, standard operating procedures,
workflows, Member insurance products and benefits, community
resources and programs, and applicable regulatory, state, and NCQA
requirements. May identify cases to be presented at care management
rounds and follows up with providers on recommendations to achieve
optimal outcomes for Members. Support a positive workplace
environment, collaborate, and share clinical knowledge and skills
to support our culturally and demographically diverse Member
population. Face-to-face visits may be required at the Member’s
residence, provider’s office, hospitals, other acute location or
community location for education and/or assessment. Other duties as
assigned. Education/Experience Minimum of 3 years of professional
practice working with adults and/or pediatric patients with
behavioral and physical health disorders within an acute care,
community health, or ambulatory care setting. Case management
experience, preferably within a managed care organization, desired.
Demonstrate ability to be self-directed, independent, adaptive,
flexible to change, and able to collaborate as a member of a team
in a fast-paced, ever-changing environment. Demonstrate awareness,
attitude, knowledge, and skills needed to work effectively with a
culturally and demographically diverse population. Demonstrate
strong organizational and time management skills with the ability
to prioritize and follow through on multiple items in a timely
manner. Demonstrate knowledge and experience in assessing Member’s
situation, developing a care plan, and teaching self-management.
Licensure: Requirements for RN: Current, unrestricted Ohio RN
license in good standing. Associate degree in nursing required.
Bachelor’s degree preferred. Requirements for LSW/LMSW/LISW/LPC:
Bachelor' or Master’ degree in social work and current,
unrestricted Ohio LSW/LMSW/LISW/LPC license in good standing. Valid
driver’s license and car insurance. Skills & Abilities: Proficiency
using MS Office (Word, Excel, Outlook, Teams), SharePoint, internet
applications, and electronic medical record and documentation
programs. 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, Pennsylvania, 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 . 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. PH
Keywords: AmeriHealth Caritas, Columbus , RN Care Coordinator, Healthcare , Dublin, Ohio