D-SNP Care Manager (RN) - Hybrid

CenCal Health•Santa Barbara, CA

2d•$107,053 - $160,580•Hybrid

About The Position

The D-SNP Care Manager RN requires advanced clinical judgment, knowledge of Medicare Advantage and Medi-Cal regulations, strong communication skills, and a commitment to delivering person-centered, integrated care to a vulnerable and high-risk population. The core functions of the D-SNP Care Manager RN role: Conduct Comprehensive Member Assessments Perform thorough assessments of members’ medical, behavioral, functional, and psychosocial needs to identify risk factors and inform individualized care planning. Develop and Implement Individualized Care Plans Create, monitor, and update person-centered care plans in alignment with the D-SNP Model of Care, ensuring services are timely, appropriate, and cost-effective. Coordinate Integrated, Interdisciplinary Care Collaborate with members, families, providers, and care teams to ensure seamless communication, care transitions, and access to necessary services and community resources. Promote Health Outcomes and Reduce Utilization Risks Address barriers to care, reduce avoidable hospitalizations and emergency room visits, and support members in achieving their optimal health outcomes through proactive care management.

Requirements

Clinical Expertise: Strong clinical knowledge of adult chronic conditions, complex co-morbidities, functional and cognitive decline, and behavioral health issues common in D SNP populations.
Person Centered Care & Cultural Sensitivity: Excellence in customer service and patient engagement; ability to interact effectively with members, caregivers, interdisciplinary care teams, and community agencies with diverse backgrounds, values, and cultural beliefs.
Comprehensive Assessment Skills: Ability to assess medical, behavioral, functional, psychosocial, and social determinants of health needs to create individualized, person centered care plans.
Critical Thinking & Problem Solving: Uses conflict resolution, negotiation, and creative problem solving skills to overcome barriers to care and support member self management.
Communication: Excellent verbal and written communication skills for members, families, providers, and internal teams; ability to compose professional, grammatically correct correspondence, documentation, and care plans.
Care Coordination & Collaboration: Ability to coordinate care across settings, convene and participate in interdisciplinary care team (ICT) meetings, and partner with PCPs, specialists, community supports, and transportation services to support holistic care.
Regulatory Knowledge: Familiarity with CMS and DHCS requirements for D SNPs, including Model of Care elements, Health Risk Assessments, individualized care planning, interdisciplinary care teams, transitions of care, and member engagement standards.
Quality Improvement Orientation: Understanding of quality metrics (e.g., STAR, HEDIS), preventive care guidelines, and performance improvement processes relevant to D SNP populations.
Documentation & Systems Proficiency: Proficient in using electronic medical records (EMR), care management platforms, Microsoft Office (Word, Excel, Outlook), and internal tracking tools for timely and accurate documentation.
Autonomy & Accountability: Demonstrates initiative and ability to work independently while collaborating effectively in a cross functional, team oriented environment.
Time Management & Prioritization: Ability to meet deadlines, manage competing priorities, and complete D SNP required activities within specified timeframes.
Adaptability & Influence: Flexible, open to change, and skilled in building consensus and influencing individual and group decision making.
Member Advocacy: Commitment to empowering members to actively participate in their care, promoting independence and improved health outcomes.
Current and unrestricted Registered Nurse (RN) license in the state of California with a minimum of years (3) years of experience in this nursing role in a managed care setting, hospital, health plan or other equivalent setting.
Certification in Case Management (e.g., CCM, ACM) or obtain within two years of employment.
Minimum of 3–5 years of clinical nursing experience in acute care, complex case management, care coordination, chronic disease management, transitions of care, or related fields.
Experience managing medically complex, high risk, or vulnerable adult populations, ideally in a Medicare Advantage, Medi Cal, or special needs plan (SNP) setting.
Prior experience conducting comprehensive assessments and developing person centered care plans.

Nice To Haves

Bachelor of Science in Nursing (BSN) preferred
Bilingual or another language in addition to English
Knowledge of CMS and DHCS D SNP regulatory requirements, Model of Care elements, and documentation standards highly desirable.