SNP Case Manager

People are the most important asset of Imperial, for this reason the difference and plurality of people, equality of opportunities, non-discrimination and inclusion in the workplace are priority and strategic factors in the Organization. Imperial maintains a strong will to promote Diversity, Equity, and Inclusion, through inclusive leadership as a lever change and business sustainability.

Imperial Health Plan of California, Inc. is approved by California Department of Managed Health Care to offer full-service Medicare Advantage coverage, including a Medicare Advantage Prescription Drug plan, and a Chronic Condition Special needs plan over numerous counties in California. Through its affiliates, Imperial Insurance Companies and Imperial Health Plan of the Southwest, Imperial also offers covered services to eligible individuals under the Affordable Care Act-Obamacare in numerous counties in Texas, Utah, Nevada and Arizona.

Our Mission: To deliver valuable care so that members are healthy in body, mind, and spirit to achieve their inherent potential.

Our Vision: To deliver value based care that is clinically effective, sustainable, and achieves exceptional outcome.

JOB DUTIES:

Responsible for health care management and coordination within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. The SNP Case Manager will connect with the members on the phone to implement and tailor care plans according to the member’s needs. Along with other members of the health team, conduct comprehensive assessments that include the medical, behavioral, pharmaceutical and social needs of the patient, identify gaps in care and barriers to attaining improved health. Based on this assessment, and in conjunction with the member, the member’s physician and other members of the health team, create and implement a care plan that will address the identified needs, remove the barriers and improve the health of the member.

ESSENTIAL JOB FUNCTIONS:

1. Coordinate care by serving as a resource for the member, their family and their physician.

2. Measure, improve and maintain quality outcomes (clinical, financial, and functional) for individual patients and the population served.

3. Ensure access to appropriate care for members with urgent or immediate needs facilitating referrals/authorizations within the benefit structure as appropriate.

4. Assesses the member’s current health status, resource utilization, past and present treatment plan and services; prognosis, short and long term goals, treatment and provider options.

5. Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

6. Conducts and participates in IDT meetings.

7. Interfaces with Primary Care Physicians, Nurse Practitioners and specialists on the development of care management treatment plans.

8. Provide education and self-management support based on the patient’s unique learning style.

9. Assists in problem solving with providers, claims or service issues.

10. Measures the effectiveness of interventions to determine case management outcomes.

11. Works closely with delegated or contracted providers, groups or entities (as assigned) to assure effective and efficient care coordination.

EDUCATION/EXPERIENCE:

· 2+ years of nursing experience in an acute care hospital setting

· 1+ years of managed care and utilization review experience

· Experience with clinical review

SKILLS/KNOWLEDGE/ABILITY:

· Spanish speaking or other second language a plus

LICENSURE/CERTIFICATE/TRAINING:

· · Unrestricted CA, NV, TX or Compact RN license or CA, NV, TX LVN license from an accredited school