Description:

POSITION OVERVIEW The SNP / CMC Care Manager is responsible for managing low and moderate risk Special Needs Population (SNP) and Dual Eligible (DE) members. SNP / CMC Care Manager will ensure that the SNP and DE receive an assessment.

RESPONSIBILITIES AND FUNCTIONS

? Managers a case load of 400-600 low to moderate risk SNP and or CMC members. ? Coordinates and schedules all IDCT meetings ? Ensures all SNP and DE members are presented at IDCT at least annually ? .Facilitates Primary Care Provider attendance ? Ensures SNP and DE member and or caregiver participation ? Obtains the health plan HRA from various websites ? Oversees the low risk SNP and DE population and ensures the annual review of the care plan is completed for those members who did not have a change in health status. ? Manages all communication and information flow ? Completes the model of care training annually ? Works collaboratively with the patient, physician, family/significant other and providers of healthcare to implement plan of care to meet the individual needs. ? Works collaboratively with discharge planners at the affiliated hospitals and case management staff to identify changes in health status. ? Coordinates referrals to LTSS as indicated. ? Provides patients with education and training regarding specific health care needs. ? Monitors care, which is easily accessible with no access barriers as related to the patient’s available benefits. ? Facilitates early and intensive treatment intervention in the least restrictive setting. ? Facilitates the scheduling of follow up services as appropriate. ? Provides accurate and up-to-date information to practitioners regarding clinical practice guideline criteria and patient information. ? Creates individualized treatment plans that incorporate the HRA, community LTSS services ? Utilizes multidisciplinary clinical, rehabilitative and support services. ? Grants adequate attention to patient satisfaction through the evaluation and improvement of the care coordination process. ? Upholds strict rules of confidentiality. ? Provides ongoing Care coordination program analysis and development. ? Encourages collaborative collegial approaches to the Case Management process. ? Promote the Care coordination Program’s viability and accountability. ? Other duties as assigned Level of Education : Associates degree in Nursing or BSN preferred Professional Certification or License • Active RN or LVN license in the State of California • Valid California Driver’s license and insurance Level of Experience • A minimum of 2 years experience in managed care environment, preferably in an IPA or MSO. Other case management experience will be considered. Specific Knowledge, Skills, and Abilities • Knowledge of HMO UM and QM Processes. • Knowledge of and experience with the utilization of UM criteria such as Milliman & Robertson, Medicare and Medicaid guidelines, health plan criteria, etc. • General knowledge of IPA Operations • Familiar with various financial risk arrangements • Computer literate in Microsoft Word and Excel. • Strong verbal and written communication skills. • Knowledge of and experience with medical coding. • Strong ability to work effectively with physicians and other clinical and operational staff, both written and verbally. • Self motivated with strong organizational skills. • Ability to look at challenges as opportunities. • Flexible and adaptable of schedule to attend various meetings and/or promotional events. • Ability to read quickly with excellent comprehension and retention. What software skills are needed? They need to know Outlook, MS Office What are the hours? ( Training hours?) Hours are 8-5 with a 1 hour lunch or 8:30 – 5 with ½ hour lunch. Training hours about 1 week

worksite location – location is 18 Centerpointe Drive, La Palma, CA 90623