SNP Engagement Specialist

The SNP Engagement Specialist reports to SNP Care Management Operations Leadership and plays a crucial role in the health plan's medical management team. This position focuses on providing ongoing coordination of care to members, with a commitment to improving their health status.

About the role

This role is dedicated to ensuring overall excellence in care management and is committed to the continuous improvement of member health outcomes. The team member will have high organizational visibility and responsibility in achieving these goals.

Responsibilities

• Participate in activities related to care management program build, implementation, oversight, and delegation.
• Affirm compliance with CMS SNP Model of Care (MOC) expectations, NCQA standards, and Medicare Advantage regulatory requirements.
• Assist in the coordination of transitions of care in collaboration with the Care Management clinical staff.
• Support the CM in guiding members through Health Risk Assessment completion and document responses accurately in required systems.
• Coordinate services with guidance from the Care Management clinical staff and ensure timely follow-ups with members and/or their caregivers.
• Educate members on DSNP supplemental benefits and assist with accessing these services.
• Schedule PCP visits, annual wellness visits, and preventive screenings for members.
• Act as a primary point of contact for D-SNP members to engage with the CM team.
• Collaborate with CM and/or Social Work staff to address socio-economic issues and ensure appropriate access to care.
• Generate and coordinate various member and provider communications.
• Accurately document in members' cases to ensure coordination of care needs.
• Adhere to all relevant CMS, Code of Federal Regulations, local/state/national regulatory requirements and guidelines.
• Conduct outbound and inbound calls to welcome DSNP members to the plan, explain benefits, and encourage service use.
• Ensure accuracy of data entry to prevent downstream errors.
• Identify and escalate urgent member needs when necessary.

Qualifications

• Minimum qualifications: High School diploma or equivalent, one year of working in a healthcare or managed care setting, and one year of customer service experience.
• Prioritizing preferred qualifications: Associate Degree in related healthcare field, experience with Medicare, Medicaid, or SNP populations, and familiarity with CMS regulatory and contractual documents.

Skills and Abilities

• Demonstrated knowledge of CMS regulatory and contractual documents, Medicare Advantage, NCQA accreditation standards, disease management, utilization management, care management, and discharge planning.
• Excellent written and oral communication skills.
• Problem-solving capabilities to drive improved efficiencies and customer satisfaction.
• Attention to detail.
• Proficiency with Microsoft Office products.
• Ability to work under stressful conditions and meet defined deadlines and deliverables.
• Excellent interpersonal, analytical, computer, organizational, verbal, and written communication skills.
• Ability to identify problems and opportunities and communicate effectively to management.

Physical Requirements:

• 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.

Schedule:

• Scheduled Weekly Hours: 40
• Shift: United States of America (Non-Exempt)
• Company: PHH Peak Health Holdings
• Cost Center: 2403
• PHH Medical Management