Case Manager (Special Needs Plan)
Job Number: 941
Position Title: Case Manager
The Special Needs Plan (SNP) RN Case Manager is 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 RN Case Manager will connect with the patients in person or on the phone. 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 patient, the patient’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 patient.
(May include but are not limited to)
- Coordinate care by serving as a resource for the patient, their family and their physician.
- Measure, improve and maintain quality outcomes (clinical, financial, and functional) for individual patients and the population served.
- Ensure access to appropriate care for members with urgent or immediate needs facilitating referrals/authorizations within the benefit structure as appropriate.
- 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.
- Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
- Interfaces with Primary Care Physicians, Extensivists, Nurse Practitioners and specialists on the development of care management treatment plans.
- Provide education and self-management support based on the patient’s unique learning style.
- Negotiates rates of reimbursement, as applicable.
- Assists in problem solving with providers, claims or service issues.
- Measures the effectiveness of interventions to determine case management outcomes.
- Works closely with delegated or contracted providers, groups or entities (as assigned) to assure effective and efficient care coordination.
- Maintains confidentiality of all PHI in compliance with state and federal law and Alignment Healthcare Policy.
- 1-3 years clinical experience
- 3-5 years of case management experience; or any combination of education and experience, which would provide an equivalent background.
- Health Plan experience preferred
- Must have and maintain an active, valid and unrestricted RN license in the state for which you are applying
- Case Management Certification preferred
- Possess a high level of understanding of community resources, treatment options, home health, funding options and special programs
- Extensive knowledge of the management of chronic conditions
- Excellent verbal and written communications skills
- Excellent case preparation and abstracting skills
- Team player who builds effective working relationships
- Ability to work independently
- Experience using standardized clinical guidelines required
- Strong organizational skills
- Ability to operate PC-based software programs including proficiency in Word, Excel and PowerPointEssential
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
- The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Location City: Jacksonville
Location State: Florida
Community / Marketing Title: Case Manager (Special Needs Plan)
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.
EEO Employer Verbiage:
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact email@example.com.