RN Case Manager (Hybrid) - SNP Special Needs Plan - 40 Hours Weekly - HAP Health Alliance Plan

RN CASE MANAGER (HYBRID) - SNP SPECIAL NEEDS PLAN - 40 HOURS - DAY SHIFT - HAP HEALTH ALLIANCE PLAN

Full Time Benefit Eligible

Schedule: Monday through Friday, 8:00AM to 4:30PM, Hybrid

GENERAL SUMMARY:

Unit Description: 

Health Alliance Plan (HAP) is looking to grow our Case Management Team with experienced Registered Nurses!  In this role, you will oversee Case Management for our Chronic-Special Needs Program (C-SNP) and Dual-Special Needs Program (D-SNP) group.  We provide services to Medicare eligible patients based on the standard criteria for the plan (see more here). Following completion of orientation, our staff typically manages a workload of approximately 100-150 cases at one time.  

Our team is made up of seasoned Registered Nurses and additional support staff.  We are a close-knit group always willing to jump in and assist each other.  The ideal candidate has a minimum of three years of nursing experience, will be team-focused, able to work independently, and thrive in a setting that is consistently evolving.  Though we primarily work from home, we do occasionally travel for in person meetings and trainings at our Troy Corporate Headquarters.  Interested in learning more? Apply now!

Responsible for case management activities for Health Alliance Plan (HAP) Special Needs Plan (SNP) members using a multi-disciplinary, patient-centered approach. Provides bio/psycho/social assessments, develops an individualized care plan, implements case management interventions, facilitates an interdisciplinary care team, coordinates care, monitors outcomes and evaluates the delivery of quality, cost effective health care services across the continuum of care. Oversees the day-to-day operations of member-centered comprehensive care coordination for members enrolled in special needs plan programs, while ensuring adherence to all regulatory requirements.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Facilitate access of healthcare services for SNP eligible members and identify plans for strategies to reduce avoidable utilization and encourages appropriate resource use. Works with physicians and other health care providers to adjust plans of care as required.
• Provide liaison services to SNP members and providers. Represents HAP in the community to peers, physicians, and providers as a member advocate for the HAP SNP population.
• Conducts assessments of member’s needs including current health conditions, preventive screenings, medical service utilization, cognitive/functional status, social determinant of health concerns, including food insecurity, transportation and housing, and behavioral health concerns including depression and substance use screening.
• Collaborates with external resources/agencies and post-acute care health teams to optimize the members outcomes and improve the care experience when transitioning to the next level of care or home.
• Familiarity, comprehension, and compliance with the Special Needs Plan Model of Care (MOC).
• Attend and actively participate in the SNP member advisory committee, offering oversight and resolution as necessary based on feedback received.
• Develop, implement, monitor, and modify a plan of care through an interdisciplinary and collaborative team process, in conjunction with the member, the caregivers and the healthcare team.
• Maintain a level of competency and knowledge related to case management, disease processes and acute illnesses to assist with care coordination.
• Advocates for the member/family/caregiver throughout episodes of care.
• Maintains availability to member/family/caregiver as a resource to facilitate communication among the multidisciplinary team and to monitor services rendered. Remains involved throughout the member’s enrollment in the SNP plan.
• Develops and maintains relationships with internal and external resources to ensure member needs are met. Identifies the need for and coordinates mental health/substance abuse interventions within HAP (or designee).
• Uses independent, clinical judgment and discretion to address, resolve, and process problems impeding the diagnostic or treatment process. Proactively identifies and resolves delays and obstacles.
• Facilitates referrals for additional medical and ancillary services, including home healthcare, infusion therapy, palliative care, hospice, inpatient extended care facilities, and medical equipment and supplies, as needed.
• Participate in the development of cost savings opportunities through the identification of quality management, case management, and multi-disciplinary processes.
• Refer cases to Physician Advisors and/or Plan Medical Directors when appropriate, where quality issues are identified.
• Coordinate and assist in the development of innovative alternative care delivery mechanisms to meet special needs of members.
• Maintain electronic medical records including professional, clinical documentation to ensure continuity of care and compliance to regulatory requirements (e.g., HIPAA, SNP Model of Care, CMS guidelines).

This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and duties. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described above.