SNP Lead Care Manager- PEAK
About The Position
Reporting to SNP Care Management Leadership, the SNP Lead Care Manager will be an integral member of the health plan’s medical management team. This position is responsible for onboarding new employees and mentoring members of the SNP care management team, including providing education, performing documentation audits, and building clinical team members' expertise through direct feedback and real-time coaching. This position is committed to the constant pursuit of excellence in improving the health status of our members and community. This team member will have high organizational visibility and responsibility in ensuring overall excellence in all areas of care management.
Requirements
- Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC).
- Five (5) years of healthcare clinical experience.
- Two (2) years’ Care Management, Case Management or Population Health experience.
Nice To Haves
- Bachelor's Degree in Nursing OR Associate of Science in Nursing Degree (ASN) or Diploma.
- Management of Medicare and/or Medicaid and/ or SNP populations.
- One (1) year SNP Care Management experience.
Responsibilities
- Participate in activities related to care management program build, implementation, oversight, and delegation.
- Assist in ensuring compliance with CMS SNP Model of Care (MOC) expectations, NCQA standards, and Medicare Advantage regulatory requirements.
- Assist in the development and implementation of policies and procedures related to the Care Management process.
- Assist with monitoring performance standards, productivity and ensuring staff coverage to meet the needs of the department.
- Formulate, implement and evaluate educational strategies for staff.
- Maintain a working knowledge of the requirements of regulatory and compliance entities.
- Mentor new Care Managers and assist with training.
- Provide support and coaching to Care Managers and other clinical team members.
- Perform data collection and analysis of trends to determine areas of opportunity and strategies for better practices for the Care Management team.
- Take escalated calls or fill-in for the Care Manager team during high-peak periods.
- Assist in quarterly reporting of delegated case management processes to meet accreditation standards.
- Assist in submission of required documents/policies during application process to accrediting body.
- Provide clinical, procedural or interpretational assistance.
- Ability to present complex ideas and data to a wide variety of stakeholders from frontline employees to executive c-suite.
- Establish and maintain cooperative and positive working relationships with key stakeholders across the organization.
- Participate in the Interdisciplinary Care Team (ICT) in conjunction with the SNP CM team, PCP and beneficiary/caregiver.
- Assist in using Peak Health’s analytics tools to monitor HRA timeliness, care plan compliance, ICT effectiveness, utilization trends, and quality outcomes.
- Serve as a key liaison between SNP Care Management, Peak Health providers, pharmacy, behavioral health partners, and community agencies.
- Support escalation and review of high-risk, high-need member cases to ensure appropriate interventions, community resource connections, and care plan adjustments.
- Assist Peak’s Quality Management and Compliance teams to support Stars improvement, HEDIS performance, utilization management coordination, and audit readiness.
- Support escalation and review of high-risk, high-need member cases to ensure appropriate interventions, community resource connections, and care plan adjustments.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
