Care Manager – SNP
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Job Description
Registered Nurse coordinating care plans, transitions, and resources for Peak Health’s Medicare Advantage SNP members. Supporting compliance, quality oversight, and member outcomes remotely.
Responsibilities:
- Provide coordination of care to SNP members, including establishing and maintaining care plans
- Coordinate care with Interdisciplinary Care Team members and during transitions of care
- Participate in care management program build, implementation, oversight, and delegation
- Conduct intake assessments with members and families
- Develop individualized care plans accounting for physical, financial, and other constraints
- Serve as liaison for the Interdisciplinary Care Team with PCPs and beneficiaries/caregivers
- Provide resources and benefits education to beneficiaries/caregivers to improve self-management and quality of life
- Collaborate with care management team members to support beneficiaries through transitions of care
- Act as primary contact for members/caregivers, PCPs, specialists, and ancillary providers
- Audit member records using NCQA standards
- Review Health Risk Assessment data to guide programs and services
- Manage and triage member self-referrals to care management programs
- Participate in case management and quality committees
- Review medical records and investigate potential quality-of-care issues
- Assist with quarterly reporting of delegated case management processes
- Connect members with in-network providers and community resources
- Identify barriers to members achieving maximum quality of life
- Perform virtual face-to-face visits when needed
- Help ensure compliance with CMS SNP Model of Care, NCQA standards, and Medicare Advantage requirements
Requirements:
- Current Registered Nurse license issued by the state where services will be provided, or current multi-state RN license through the enhanced Nurse Licensure Compact (eNLC)
- Three years of healthcare clinical experience
- One year of Care Management, Case Management, or Population Health experience
- Preferred: Bachelor's Degree in Nursing, Associate of Science in Nursing degree (ASN), or Diploma
- Preferred: Experience managing Medicare, Medicaid, and/or SNP populations
- Preferred: One year of SNP Care Management experience
- 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
- Attention to detail
- Proficiency with Microsoft Office products
- Ability to work under stressful conditions
- Ability to meet defined deadlines and deliverables
- Ability to stand and walk short distances for eight or more hours
- Frequent bending, stooping, or stretching
- Ability to lift 30 pounds and push 50 pounds
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