SNP Telephonic Case Manager (LVN or RN)

About the position The SNP Telephonic Case Manager I is an entry-level position responsible for serving as a point of contact for assigned members within the Special Needs Plan (SNP). This role focuses on care coordination, utilizing the SNP Model of Care to manage the medical, cognitive, psychosocial, and functional needs of members through individualized care plans. The position involves maintaining a caseload of approximately 150-175 members, ensuring compliance with health plan standards, and collaborating with the Interdisciplinary Care Team (ICT). Responsibilities • Serve as a point of contact for assigned members and provide care coordination as designated by Health Plan Special Needs Plans (SNP). , • Utilize the SNP Model of Care to manage the medical, cognitive, psychosocial, and functional needs of each assigned member. , • Develop individualized care plans in collaboration with members and 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. , • Monitor assigned SNP members and manage their healthcare conditions. , • Educate members on the importance of following up with their Primary Care Provider (PCP) and utilizing Immediate Care (IC) facilities. , • Discuss Serious Illness Discussions and Life Planning with members regularly. , • Document using the Problem, Intervention, Plan (PIP) format in the Electronic Health Record (EHR) in a timely manner. , • Complete the Clinical Social Assessment (CSA) annually on all assigned members and update as necessary. , • Collaborate with other members of the Interdisciplinary Care Team (ICT) to meet the needs and plan of care for members. , • Escalate issues and/or concerns to department management following the departmental chain of command. Requirements • Completion of an accredited nursing program. , • Current California Licensed Vocational Nurse (LVN) License or Registered Nurse (RN) License. , • 1 year of nursing experience that involves direct patient care in a hospital or skilled nursing facility setting. , • Knowledge and competence in chronic disease pathophysiology, polypharmacy, clinical assessment, and patient-family education. , • Ability to effectively communicate with individuals at 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. Nice-to-haves • Bilingual preferred; ability to speak, read, and write in English and Spanish fluently.

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