Care Manager – SNP

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

📋 Description

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

• Conduct intake evaluations with members and their families.

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

• Coordinate with the Interdisciplinary Care Team, Primary Care Provider (PCP), and beneficiaries/caregivers.

• Offer resources and educational materials on benefits to enhance self-management and overall quality of life.

• Collaborate with team members during transitions of care.

• Act as the primary liaison for members/caregivers, PCPs, specialists, and ancillary providers.

• Audit member records in accordance with NCQA standards.

• Analyze Health Risk Assessment data to inform program and service development.

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

• Participate in case management and quality improvement committees.

• Review and update activities and resources in response to member needs.

• Examine medical records and documentation to guarantee quality care.

• Investigate potential quality-of-care concerns that may impact member health or safety.

• Assist in the quarterly reporting of delegated case management procedures.

• Aid members in understanding their medical benefits and connecting with in-network providers and community resources.

• Identify obstacles to achieving optimal quality of life.

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

• Ensure compliance with CMS SNP Model of Care, NCQA standards, and Medicare Advantage regulations.

⛳️ Requirements

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

• A minimum of three years of clinical experience in healthcare.

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

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

• Ideally, one year of experience specifically 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.

• Exceptional written and verbal communication skills.

• Strong problem-solving abilities.

• Keen attention to detail.

• Proficient in Microsoft Office applications.

• Capability to work effectively in high-pressure environments.

• Ability to meet established deadlines and deliverables.

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

• Frequent bending, stooping, or stretching required.

• Ability to lift 30 pounds and push 50 pounds.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and continuing education.

• Supportive work environment with a focus on teamwork and collaboration.

• Flexible work schedules to promote work-life balance.