What are the responsibilities and job description for the SNP Telephonic Case Manager I (PS) position at Desert Oasis Healthcare?
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).
- Maintain an average caseload of approximately 150-175 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.
- Completion of an accredited nursing program.
- Current California Registered Nurse (RN) 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.
