RN/LVN SNP Telephonic Case Manager I

The Special Needs Plan (SNP) Telephonic Case Manager I is the entry level position of the SNP Telephonic Case Manager positions and is responsible for serving as a point of contact for assigned members and providing care coordination designated by Health Plan Special Needs Plans (SNP). The SNP Telephonic Case Manager I utilizing the SNP Model of Care for managing the medical, cognitive, psychosocial and functional needs of each assigned member through the development of an individualized care plan with the member. Each individualized member care plan is reviewed by the Interdisciplinary Care Team (ICT). Professional Duties

Maintain an average caseload of approximately 200-250 members.

Achieve an overall audit-accuracy rating standard of 85% or better.

Responsible for monitoring assigned Special Needs Plan (SNP) members, managing the member's healthcare conditions, prioritizing healthcare needs and educating the member in an effort to prevent complications and avoid utilizations.

Educate the member on the importance of following up with their Primary Care Provider (PCP) regularly, the use of Immediate Care (IC) facilities, and the Case Manager as the single point of contact, in order to prevent unnecessary utilizations.

Serious Illness Discussions and Life Planning, such as POLSTS and DPOAs will be discussed with members regularly, and will also routinely address the importance of preventative care and the need for appropriate follow-up with those Health Care Professionals rendering health care with focus on needed quality measures.

Document using the Problem, Intervention, Plan (PIP) format, in the Electronic Health Record (EHR) in a timely manner. Documentation must comply with nursing standards, company policies and procedures and the requirements mandated by health plans, CMS and NCQA in order to meet routine audits.

Completes the Clinical Social Assessment (CSA) annually on all assigned members. The Case Manager determines an acuity score for necessary follow-up. The Acuity Score – 1, 2, or 3 is determined by identifying the member’s medical and social needs. The CSA will be updated as health care needs and conditions change.

After completing the CSA with the member and obtaining their input and agreement; the Case Manager develops an individualized plan of care with goals that are Specific, Measurable, Attainable, Realistic, and Time Bound (S.M.A.R.T.) which address the goals the member wishes to work on, to include a self-management, goal oriented individualized care plan. The Individualized Care Plan will be updated as necessary as health care needs and conditions change and or on an annual basis.

Collaborate with other members of the Interdisciplinary Care Team (ICT) to meet the needs and plan of care for the members.

Escalate issues and/or concerns to department management following the departmental chain of command.

Perform other duties as assigned.

Be an active listener (make eye contact, validate)

Anticipate needs that will arise before your next meeting Qualifications

Completion of an accredited nursing program.

Current California Licensed Vocational Nurse (LVN) License.

1 year of nursing experience that involves direct patient care in a hospital or skilled nursing facility setting, preferred.

Knowledge and competence in chronic disease pathophysiology, polypharmacy, clinical assessment, and patient-family education.

Ability to effectively communicate with individuals within all levels of the organization, patients, patient family members, providers, vendors and others.

Ability to utilize Microsoft Office applications (Word, Excel, Outlook, Power Point) and other computer software/applications.

Ability to collaborate with others and be an active member of a cross-functional team. Ability to work independently with minimal supervision.

Ability to anticipate needs and manage time effectively and prioritize tasks to meet established deadlines.

Bilingual preferred. Ability to speak, read and write in English and Spanish fluently, preferred.

At the discretion of DOHC/FHC management, this position has the potential to be a full or hybrid telecommuting position. Physical Demands

Sitting: Approximately 70% of day.

Standing: Approximately 15% of day.

Walking: Approximately 15% of day.

Lifting: 0 - 20 lbs. approximately 5% of day.

Bending: Approximately 10% of day.

Hearing/Visual Acuity: Adequate for use with computers, telephone/mobile device and other office equipment approximately 90% of day.

Computer: Highly technical work environment. Must be able to work 7+ hours per day using computers, telephone/mobile device and other office equipment.

Reaching: Above head 75 degrees approximately 15%.

Hand grip dexterity: Approximately 70% of day.

Nursing policy compliance, Collaborate with healthcare professionals, Foreign language proficiency, Computer operation, Patient follow-up care, Care plan evaluation, Nursing, Skilled nursing facility experience, Microsoft Excel, Microsoft Outlook, Caregiving documentation requirements, LVN, Case assessment, Electronic health records (EHR) management, Disease management patient education, CMS, Experience working with individuals with chronic illnesses, Care documentation, Incident Escalation, Long-term care facility experience, Managing patients as a nurse case manager, Preventive health (patient care), Overseeing care coordination, Medical treatment knowledge, Task prioritization, NCQA standards, Clinical assessment documentation, Desktop applications, Patient family and caregiver education, Multidisciplinary team collaboration for treatment planning