Special Needs Plan (SNP) Program Case Manager

Position Type: Full Time
Location: Huntington Beach, CA or Arcadia, CA

Reports To: Manager, SNP Program

About Clever Care Health Plan

Clever Care Health Plan is a newly founded Medicare Advantage health plan serving Medicare beneficiaries in Southern California. Our employees are passionate in providing best services to our members and healthcare providers. Our three office locations are in Arcadia (Los Angeles County), Huntington Beach (Orange County) and New York City.

Job Summary

The Special Needs Plan (SNP) Program Case Manager provides a holistic care model which involves collaboration with members and their families, caregivers, and providers. An integrated (physical/behavioral health) case management model, and a collaborative, relationship-based approach, including members, health care providers and caregivers to assist SNP members to improve their health outcomes. Case managers provide a comprehensive, integrated health risk assessment of member’s current situation and status; identify actionable barriers and obtainable goals to achieve optimal self-care management; monitor member’s progress toward goals; facilitate the coordination, communication and collaboration among the member’s providers; advocate for members and promote self-advocacy; assist members to obtain appropriate quality care within their benefit plan; and identify resources in the community or within the member’s natural support system to fill any gaps within their benefit plan.

Functions and Job Responsibilities

Engage members with medical, mental health and/or substance utilization disorders in services utilizing evidenced-based engagement skills.
Conduct initial and annual health assessment of member’s current conditions, situation and needs and ongoing evaluations including evaluation of caregiver’s needs.
Conducts face-to-face visits with member
Develop, implement, and maintain the Individualized Care Plan (ICP) based on identified needs and goals of the member including stratifying the results, with input from the Interdisciplinary Care Team (ICT).
The case manager ensures that all members of the ICT receive a copy of the ICP. The case manager assists with all transition of care events and schedules and facilities needed ICT meetings along with documenting discussion and updating the ICT as needed. The case manager will schedule appointments, transportation, provide reminders, and attend appointments when needed.
Collaborate with the member, caregivers, and providers to develop a culturally sensitive case management plan that addresses barriers and promotes improved health outcomes.
Monitor and evaluate the effectiveness of the member’s case management plan and continuously update to ensure goals are progressing and remain pertinent; identify and address barriers to completing goals.
Facilitate communication and coordination among the health care team to minimize fragmentation, eliminate duplication and maximize delivery of appropriate care.
Provide interventions focused on removing the member’s barriers to health improvement; promoting positive behavior change using motivational interviewing techniques; and addressing the caregiver’s needs in order to stabilize the member’s natural support system.
Maintain concise, accurate and timely documentation that supports effective, efficient management of the member and that meets accreditation, contractual and legal requirements.

Provide education to the member and caregiver(s) about health conditions as needed. The case manager monitor progress toward ICP goals. Help member with navigating the health care continuum to reduce duplication of service and care gaps. Address social determinants of health and ensure clinical practice guidelines are being followed.
Carries out Provider’s Plan of Treatment (i.e., laboratory draws, medication reconciliation, wellness visits, etc.) and reports changes as necessary
Participates in Quality Improvement projects and data collection to determine effectiveness of the Case Management Program

Education and Experience

California Registered Nurse License
Certified Case Manager (CCM) certification is preferred
Driver’s license and auto insurance
5+ years of clinical case management experience
SNP experience in a health plan setting
Experience working with the elderly
Motivational interviewing experience

Knowledge, Skills, and Abilities

Knowledge of Medicare Managed Care Plans
Advance knowledge of Medicare Advantage CMS and California Department of Managed Health Care (DMHC) regulations
Requires the ability to prioritize, work independently and anticipate needs to make decisions
Strong organizational skills including the ability to multitask and problem solving
Excellent communication skills
Analytical and critical thinking skills are required
Exhibit initiative and ability to assume responsibility and maintain confidentiality

Physical & Working Environment

Typical Physical Demands.
Position requires a great amount of sitting and standing. Some lifting, stooping, bending, or reaching is required. May require lifting up to 15‐30 pounds. Requires manual dexterity sufficient to operate a computer, calculator and telephone. Requires normal range of hearing and vision. Requires the ability to type and file.

Typical Working Conditions.
Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. Work may be stressful at times. May occasionally work some irregular hours.