Transition Care Manager, Registered Nurse

Your career starts now. We are looking for the next generation of health care leaders.
At AmeriHealth Caritas, we are 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 would like to connect with 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.
Responsibilities:
Under the Direction of the Long Term Care (LTC) Supervisor, the Nursing Home Transition Care Manager is responsible for safe transitioning long-term care members from the custodial nursing home setting into a community setting and working wiht hospital and nursing facility staff in discharge planning to prevent community members from lapsing into a custodial nursing home placement.
This position may include, but not limited to, the following responsibilities:

• Appropriately identifies and assesses members for rebalancing.
• Review of daily ER or inpatient census of LTC plan members; follow up with assigned case manager, member, and facility discharge planner.
• Receive and process facility, member and case manager referrals for rebalancing and lapse prevention.
• Complete face to face interaction with LTC plan members at hospitals, rehabilitation, and nursing facilities.
• Complete assessments to identify gaps in care, determine members understanding of illness and outpatient managment of illness in addition to evaluating, coordinating, and implementing discharge needs.
• Work across disciplines including, but not limited to, PCP, home care, skilled nursing facilities and rehabilitation services, DME, pharmacy, case management referral for community needs and availability.
• Schedule appointments and arranging clinical follow-up calls for care coordination, and member education on how and where to seek appropriate care and follow-up services.
• Facilitate and maintain working relationships with nursing facility and assisted living facility staff including administrators, social services and clinical staff.
• Identify the need for and coordinate community support to transition.
• Conduct Interdisciplinary Care Team (ICT) meetings with ACFL LTC staff, hospital and nursing facility staff, member, and his/her care team to coordinate clinical and non-clinical care needs to support transition and/or lapse prevention.
• Assess the community setting prior to LTC member discharge to ensure the community placement has environmental supports and home-like environment setting.

Education/Experience:

• Registered Nurse active/clear licensed in the state of Florida, graduated from an accredited institution with an Associates Degree (ASN) required.
• Registered Nurse active/clear licensed in the state of Florida, graduated from an accredited institution with a Bachelors Degree (BSN) preferred.
• Minimum of 3 years nursing experience, in related clinical setting working with the disabled and elderly population.
• Managed care experience preferred.
• Discharge Planning experience preferred.
• Proficiency with Microsoft Office Suite (Word, Excel, Power Point), MS Teams, MS Outlook preferred.

Other:

• Requires face to face visits to members homes and facilities (i.e. Nursing Homes, Hospitals, Assisted Living Facilities, etc.).
• Valid drivier's license, automobile insurance and reliable transportation required.
• This requisition is in anticipation for future hiring state-wide. Ideally, applicants should reside in AHCA Regions G & I (Palm Beach & surrounding counties & Miami-Dade & Monroe counties). Also AHCA Regions D & E (Tampa & Orlando Metros).

Diversity, Equity, and Inclusion
At AmeriHealth Caritas, everyone can feel 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.
We keep our associates happy so they can focus on keeping our members healthy.
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.