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LPN or Pediatric Resource Coordinator

Company: Amerihealth
Location: Newark
Posted on: October 4, 2021

Job Description:

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 Philadelphia, 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:

As part of the care coordination team, the Resource Coordinator supports the development of and executes on the outreach strategy in a certain territory for the purposes of influencing health outcomes and member engagement.  This position is responsible for establishing and cultivating relationships with members, community stakeholders and providers.  Responsibilities include, but are not limited to:

  • Actively assisting providers in discharge planning for Level 1 members following acute episodes of care involving at a minimum one of the following services: inpatient psychiatric stay, ambulatory surgery, hospital inpatient stay, and rehabilitation facility services.
    • Assistance shall include but not be limited to: appointment setting, referrals and linkages to services, coordination of DME, and coordination of prior authorizations as needed to support the member’s timely access to services in the community
  • Assist in closing social determinants of health and care gaps through appointment assistance, coordinating transportation, connection to community resources and wellness programs
  • Establishes connection and acts as the primary ACFC contact to a targeted member population through home visits, community visits and outreach calls.
  • Exercises judgment and discretion in the coordination of care by handling basic care 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 to encourage/foster relationships with their medical/dental providers (medical/dental homes).

Education/ Experience:

  • 3 to 5 years experience.
  • Associate’s Degree in Health Care, Human Services or a related field or equivalent work experience. 
  • Bachelor’s Degree perferred.
  • Candidate must possess a valid driver’s license and be willing and able to drive a car.

Other Skills:

  • Community based care experience preferred.
  • Behavioral health experience preferred.
  • Previous experience in presenting health education materials to individuals and small groups.
  • Knowledge and understanding of medical terminology and disease processes.
  • Ability to effectively communicate preventive health and health management philosophies to member’s and agencies.
  • Comprehensive knowledge of Medicaid requirements and plan, policies and procedures.
  • Knowledge of managed care.
  • Up to 50% of time will be spent traveling.

 

 

Keywords: Amerihealth, Newark , LPN or Pediatric Resource Coordinator, Other , Newark, Delaware

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