Care Manager – SNP

This is a fully remote position, open to applicants in United States.

📋 Description

• Facilitate care coordination for SNP members, which includes the creation and maintenance of care plans.

• Collaborate with members of the Interdisciplinary Care Team and during care transitions.

• Engage in the development, implementation, oversight, and delegation of care management programs.

• Conduct intake assessments involving members and their families.

• Formulate personalized care plans that take into account physical, financial, and other limitations.

• Act as a liaison between the Interdisciplinary Care Team, PCPs, and beneficiaries/caregivers.

• Provide beneficiaries and caregivers with resources and educational support to enhance self-management and improve quality of life.

• Work alongside care management team members to assist beneficiaries during transitions of care.

• Serve as the main point of contact for members/caregivers, PCPs, specialists, and ancillary providers.

• Conduct audits of member records in accordance with NCQA standards.

• Analyze Health Risk Assessment data to inform programs and services.

• Manage and prioritize member self-referrals to care management programs.

• Participate actively in case management and quality committees.

• Review medical records and investigate potential quality of care concerns.

• Assist in quarterly reporting of delegated case management processes.

• Connect members with in-network providers and community resources.

• Identify obstacles that prevent members from achieving optimal quality of life.

• Conduct virtual face-to-face visits as required.

• Ensure adherence to CMS SNP Model of Care, NCQA standards, and Medicare Advantage requirements.

⛳️ Requirements

• A valid Registered Nurse license issued by the state in which services will be provided, or a current multi-state RN license via the enhanced Nurse Licensure Compact (eNLC).

• Minimum of three years of clinical experience in healthcare.

• At least one year of experience in Care Management, Case Management, or Population Health.

• Preferred: Bachelor's Degree in Nursing, Associate of Science in Nursing (ASN), or a Nursing Diploma.

• Preferred: Experience in managing Medicare, Medicaid, and/or SNP populations.

• Preferred: One year of experience in SNP Care Management.

• Familiarity with CMS regulatory and contractual documents.

• Understanding of Medicare Advantage, NCQA accreditation standards, disease management, utilization management, care management, and discharge planning.

• Outstanding written and verbal communication skills.

• Strong problem-solving abilities.

• Keen attention to detail.

• Proficiency in Microsoft Office applications.

• Capability to function effectively under stressful conditions.

• Ability to meet established deadlines and deliverables.

• Capacity to stand and walk short distances for eight or more hours.

• Frequent bending, stooping, or stretching may be required.

• Ability to lift up to 30 pounds and push up to 50 pounds.

🏝️ Benefits

• Competitive salary and benefits package.

• Opportunities for professional development and career advancement.

• Supportive work environment with a focus on teamwork.

• Comprehensive health and wellness programs.