Care Manager SNP- PEAK

About the role

The SNP Lead Care Manager reports to the Manager of SNP Care Management Operations and plays a crucial role in the health plan’s medical management team. This position is responsible for coordinating care for SNP members, establishing and maintaining care plans, and collaborating with interdisciplinary teams.

Responsibilities

• Participate in care management program build, implementation, oversight, and delegation.
• Conduct intake assessments with members and families.
• Develop individualized care plans that consider physical, financial, and other constraints.
• Act as a liaison for the Interdisciplinary Care Team (ICT) in collaboration with the PCP and beneficiary/caregiver.
• Provide resources and benefits to assist and educate beneficiaries/caregivers to enhance self-management skills and quality of life.
• Collaborate with other care management team members to support beneficiaries through transitional care events.
• Manage and triage member self-referrals to care management programs.
• Participate in case management and quality committees.
• Assist in reviewing and updating activities and resources to address member needs.
• Review and evaluate Health Risk Assessment (HRA) data to inform program development.
• Manage and triage member self-referrals to care management programs.
• Collaborate with other care management team members to support beneficiaries through transitional care events.
• Assist in quarterly reporting of delegated case management processes to meet accreditation standards.
• Avoid unnecessary hospitalizations and promote quality of life for members.
• Perform virtual face-to-face visits when necessary to assist members in coordinating care needs.
• Affirm compliance with CMS SNP Model of Care (MOC) expectations, NCQA standards, and Medicare Advantage regulatory requirements.

Requirements

• Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC).
• Three (3) years of healthcare clinical experience.
• One (1) year of Care Management, Case Management, or Population Health experience.

Preferred Qualifications

• Bachelor's Degree in Nursing OR Associate of Science in Nursing Degree (ASN) or Diploma.
• One (1) year of SNP Care Management experience.

Core Duties and Responsibilities

The SNP Lead Care Manager is responsible for various tasks including but not limited to:

• Participate in activities related to care management program build, implementation, oversight, and delegation.
• Conduct intake assessments with members and families.
• Develop individualized care plans that account for physical, financial, and other constraints.
• Act as a liaison for the Interdisciplinary Care Team (ICT) in conjunction with the PCP and beneficiary/caregiver.
• Provide resources and benefits to assist and educate beneficiaries/caregivers to enhance self-management skills and quality of life.
• Collaborate with other care management team members to support beneficiaries through transitional care events.
• Manage and triage member self-referrals to care management programs.
• Participate in case management and quality committees.
• Assist in reviewing and updating activities and resources to address member needs.
• Review and evaluate Health Risk Assessment (HRA) data to inform program development.
• Manage and triage member self-referrals to care management programs.
• Collaborate with other care management team members to support beneficiaries through transitional care events.
• Assist in quarterly reporting of delegated case management processes to meet accreditation standards.
• Avoid unnecessary hospitalizations and promote quality of life for members.
• Perform virtual face-to-face visits when necessary to assist members in coordinating care needs.
• Affirm compliance with CMS SNP Model of Care (MOC) expectations, NCQA standards, and Medicare Advantage regulatory requirements.

Physical Requirements

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Stand and walk short distances for eight or more hours.
• Frequent bending, stooping, or stretching.
• Ability to lift 30 pounds and push 50 pounds.

Working Environment

• Standard office environment.

Skills and Abilities

• Demonstrated knowledge of CMS regulatory and contractual documents; knowledge of Medicare Advantage, NCQA accreditation standards, disease management, utilization management, care management and discharge planning.
• Excellent written and oral communication.
• Problem-solving capabilities to drive improved efficiencies and customer satisfaction.
• Attention to detail.
• Proficiency with Microsoft Office products.
• Ability to work under stressful working conditions.
• Meeting defined deadlines and deliverables is an imperative skill for this role.