Clinical Case Manager DE Long Term Services & Support
Posted on: October 5, 2021
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
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.
The Clinical Case Manager assists members who are eligible for
LTSS in obtaining the services they need as required by DSHP Plus
LTSS. He or she contributes to the LTSS case management process by
performing telephonic and/or face-to-face assessments for the
identification, evaluation, coordination and management of member’s
needs, including physical health, behavioral health, social
services and long term services and supports. This position is also
responsible for completing Level of Care Redeterminations for home
and community based members annually. This requires clinical review
when evaluating the need for a member to remain in the program. The
Clinical Case Manager will also provide clinical support to his/her
non-licensed counterparts and may act as a secondary case manager
when a member is experiencing an acute episode.
Key Accountabilities and Responsibilities
Conducts reevaluation of level of care annually or more
frequently as needed in accordance with DSHP Plan Plus LTSS
Provides clinical support to non-licensed case managers as
Conduct condition specific assessments with members with
chronic conditions. Provide education and routine follow-up with
Perform initial clinical assessment of new members, develop
care plan, and initiate services.
Facilitate person-centered planning team meetings to coordinate
care and services. Identify, coordinate, and assist participants in
gaining access to needed LTSS and other Covered Services, as well
as non-covered medical, social, housing, educational, and other
services and supports.
Provides information to participants and conducts monitoring of
authorized services and supports for Participants.
Informs participants about available LTSS required needs
assessments, the care plan process, service alternatives and
service delivery options.
Informs participants of their rights and responsibilities as
well as assists with the complaint, grievance, and DHS Fair Hearing
Collects additional necessary information, including
participant preferences, strengths, and goals to inform the
development of the Plan of Care.
Conducts comprehensive needs assessments annually or more
frequently as needed in accordance with requirements.
Review and acting upon worklists in Jiva, including monitoring
of new members.
Authorize urgent services when needed.
Monitoring critical incident reporting/documentation,
recommending/taking action w/ other corporate entities as
Liaison activities with Physical health Care Coordination
Delaware licensed RN or LCSW.
Valid driver’s license required.
At least three years working in social service or health care
Experience working with people with disabilities or seniors in
need of LTSS.
Knowledge of the home and community-based service system and
how to access and arrange for services.
Experience conducting LTSS needs assessments and monitoring
Ability to provide informed advocacy.
Ability to interact with health care professionals in a
Ability to travel up to 75%.
Knowledge of or experience with behavioral health and substance
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