The SNP Case Manager is responsible for conducting data collection, disease education and quality activities in accordance with HI policies and procedures. The position responsibilities includes telephonic outreach to members and creation of care plans to ensure costs are contained and quality of care is maintained as the patient accesses care and services in the continuum of care.
This position functions within a multidisciplinary Care Team. The SNP Case Manager uses established criteria to determine if there is a need to refer members into Case Management. The SNP Case Manager will perform activities such as health education and teaching, and will participate in the development of care plans.
• Understands and adheres to Special Needs Program-Model of Care program goals and objectives;
• Communicates with the multidisciplinary team within the timeframes required to meet program goals and objectives;
• Performs telephonic interviews for data collection and provide health education in accordance with Health Integrated policy and procedure;
• Summarizes and documents pertinent verbal discussions with the patient/patient's legally appointed representative, family, practitioner, other health care provider;
• Collects information related to the member’s strengths, problems, prognosis, functional status, goals and need for specific services/resources, to assist with establishing care plan goals;
• Refers cases to HI legal and/or health purchaser’s legal staff where there is a threat of litigation and/or those patient's specified by the legal department for immediate referral;
• Identifies and communicates to supervisor/manager any concerns related to patient safety;
• Develops an individualized member care plan in collaboration with the patient/patient's legally appointed representative, practitioners, and the multidisciplinary team members;
• Sets realistic goals for the patient as the care plan is developed;
• Readily available to non-licensed staff to answer questions and ensure that non-clinical staff is performing within the scope of the non-licensed role;
• Maintains a working knowledge of the health plan contract requirements and regulatory requirements.
• Creates and supports a positive and supportive working environment;
• Identifies and resolves potential personnel/peer problems and issues proactively;
• Communicates to Supervisor and Manager all problems, issues and/or concerns as they arise;
• Maintains a courteous and professional attitude when working with all HI staff members and the management team;
• Identifies and resolves all issues and concerns related to the day-to-day case management activities in a timely manner;
• Actively participates in any SNP-MOC team meetings;
• Actively participates in any Health Integrated committee meetings as assigned; and,
• Serves as a positive role model for peers.
• Works, communicates and collaborates in a courteous and professional manner with patients and providers;
• Communicates appropriately and according to HI policy and HIPAA guidelines.
• Strong communication, documentation, clinical and critical thinking skills are essential;
• Working knowledge of details and resources required to create individualized plan of care for persons with a catastrophic or high-cost illness or injury;
• Strong problem-solving and decision-making skills are essential;
• Strong skills in dealing with difficult and challenging personalities and situations are essential;
• Excellent typing and computer skills and ability to navigate through multiple screens and platforms;
• Ability to communicate and work with a multidisciplinary team (internal and external) to facilitate day-to-day workflow; and,
• Ability to recognize and communicate any concerns or issues to management in a professional and timely manner.
Current, unrestricted RN licensure required;
Ability to obtain multi-state licensure;
A bachelors (or higher) degree in a health-related field preferred;
Bilingual (Spanish/English) strongly preferred.
Work Experience Requirements:
Three (3) years clinical practice experience;
Two-three years clinical experience in case management or acute hospital discharge planning preferred;
Three years clinical or critical care experience in medical/surgical practices or behavioral health practices desirable;
Call center knowledge desirable.