Senior Complex Case Manager (RN) - D-SNP

Central California Alliance for Health•Mariposa County, California, CA

6h•$120,000 - $140,000•Hybrid

About The Position

The Senior Complex Case Manager (RN) position is within the Care Management Department at the Alliance. This role reports to the Medicare Care Management Manager (RN) and is responsible for developing and managing individualized comprehensive care plans for Medicare Dual Eligible Special Needs Plan (D-SNP) members. The goal is to promote optimal, achievable outcomes in the most cost-effective and appropriate manner. The position involves educating members, families, providers, external agencies, and internal departments about the D-SNP Case Management Program. Additionally, the role participates in Quality Improvement studies to evaluate program effectiveness and supports D-SNP Program oversight activities. The Senior Complex Case Manager (RN) also acts as a liaison between the D-SNP Program and providers/community agencies to ensure effective implementation of program objectives.

Requirements

Current unrestricted license as a Registered Nurse issued by the State of California
Associate’s degree in Nursing and a minimum of seven years of experience in a patient care setting, including a minimum of one year of case management experience (a Bachelor’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
A minimum of one year of the required patient care experience must be in an acute or outpatient environment, working with adults and/or dual-eligible populations
Knowledge of the principles and practices of clinical nursing
Knowledge of the principles and practices of case management, including motivational interviewing and evidence-based guidelines
Knowledge of care management and coordination
Knowledge of complex chronic conditions, geriatric care, and psychosocial factors impacting health outcomes
Knowledge of the principles and practices of developing and implementing health improvement strategies to address social determinants of health
Knowledge of evidence-based practice guidelines in the development of care plans
Knowledge of electronic health record and/or care management platforms
Ability to assess member risk, define problems, develop care plans, and collaborate across disciplines
Ability to demonstrate strong critical thinking and problem-solving skills
Ability to interpret and apply policies and regulations
Ability to define issues, conduct research, interpret data, and identify and evaluate options
Ability to evaluate medical records and other health care data
Ability to organize work, manage complex priorities, and document with accuracy and timeliness
Ability to communicate effectively with a diverse population of members, including those with behavioral health issues

Responsibilities

Develops and manages an individualized comprehensive plan of care for Medicare Dual Eligible Special Needs Plan (D-SNP) members referred into the Case Management Program with the goal of promoting optimal, achievable outcomes in the most cost effective and appropriate manner
Works with and educates members, families, providers, external agencies, and internal departments on the D-SNP Case Management Program
Participates in Quality Improvement studies, to continually evaluate the program’s effectiveness and ability in promoting quality driven, cost effective, achievable goals and outcomes for members
Performs D-SNP Program oversight and support activities
Acts as a liaison between the D-SNP Program and providers and community agencies to promote effective implementation of program objectives and requirements