AmeriHealth Caritas

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, PA, 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.

Position Overview: Reporting to the Supervisor of Medicare LTSS Operations, the Medicare LTSS Care Coordinator manages care coordination for Medicare beneficiaries with complex medical, behavioral health, Long-Term Services & Supports (LTSS), and psychosocial needs. This role ensures that care is delivered by Centers for Medicare & Medicaid Services (CMS), state, and organizational guidelines, within the scope of licensure.

Key Responsibilities:

• Deliver comprehensive care coordination for Medicare members receiving LTSS and custodial care.
• Conduct telephonic and in-person clinical assessments to evaluate members’ physical, behavioral, social, and long-term care needs.
• Identify high-risk members and collaborate with the Integrated Care Team to develop and implement individualized care plans.
• Coordinate services for members with chronic conditions, co-morbidities, and disabilities to promote efficient, cost-effective care.
• Gather detailed member histories and establish personalized care goals with members, caregivers, families, and providers.
• Facilitate access to appropriate services through referrals and authorizations, including home- and community-based programs.
• Collaborate with the Medical Director and care team to develop and monitor treatment plans.
• Address service issues and assist with provider or claims-related problem-solving.
• May oversee tasks assigned to other licensed or unlicensed professionals involved in member care coordination.
• Maintain up-to-date knowledge of CMS and Department of Health & Human Services (DHHS) regulations, licensure requirements, and internal policies.
• Promote a culture of teamwork, respect, diversity, and continuous improvement.
• Participate in office meetings and field visits as required (50% or more local travel within Western Wayne and Macomb County; mileage reimbursement provided).

Education & Experience:

• Active licensure as a Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), or Licensed Master Social Worker (LMSW) required.
• Master's degree in Social Work required.
• Minimum of 3 years of experience in care coordination, case management, or related roles serving individuals with chronic conditions or disabilities.
• Strong understanding of Medicare-Medicaid Plan Long-Term Services and Supports (MMP LTSS) programs.
• Proficiency in Microsoft Office Suite (Word, Excel, etc.).
• Ability to communicate effectively with diverse populations, including those with communication barriers or assistive technology needs.
• Strong decision-making, organizational, and quality assurance skills.
• Field experience and familiarity with the Detroit and Western Wayne County area preferred.

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 include remote options, hybrid work schedules, competitive pay, paid time off, holidays, volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement, and more.