Care Manager – SNP

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Peak Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Peak Health is a health insurer and health insurance services company headquartered in Morgantown, West Virginia. It is owned by three not-for-profit health care providers: WVU Health System, Marshall Health Network, and Valley Health. Peak Health aims to improve community health outcomes by offering an inclusive, provider-led health plan for residents of West Virginia and surrounding areas. The company is committed to making health care more accessible, understandable, and collaborative, with a focus on reducing costs and administrative fees for patients and employers. Peak Health also offers Medicare Advantage coverage tailored for West Virginia seniors through partnerships with leading health systems.

📋 Description

• Provide coordination of care to SNP members, including establishing and maintaining care plans • Coordinate care with Interdisciplinary Care Team members and during transitions of care • Participate in care management program build, implementation, oversight, and delegation • Conduct intake assessments with members and families • Develop individualized care plans accounting for physical, financial, and other constraints • Serve as liaison for the Interdisciplinary Care Team with PCPs and beneficiaries/caregivers • Provide resources and benefits education to beneficiaries/caregivers to improve self-management and quality of life • Collaborate with care management team members to support beneficiaries through transitions of care • Act as primary contact for members/caregivers, PCPs, specialists, and ancillary providers • Audit member records using NCQA standards • Review Health Risk Assessment data to guide programs and services • Manage and triage member self-referrals to care management programs • Participate in case management and quality committees • Review medical records and investigate potential quality-of-care issues • Assist with quarterly reporting of delegated case management processes • Connect members with in-network providers and community resources • Identify barriers to members achieving maximum quality of life • Perform virtual face-to-face visits when needed • Help ensure compliance with CMS SNP Model of Care, NCQA standards, and Medicare Advantage requirements

🎯 Requirements

• Current Registered Nurse license issued by the state where services will be provided, or current multi-state RN license through the enhanced Nurse Licensure Compact (eNLC) • Three years of healthcare clinical experience • One year of Care Management, Case Management, or Population Health experience • Preferred: Bachelor's Degree in Nursing, Associate of Science in Nursing degree (ASN), or Diploma • Preferred: Experience managing Medicare, Medicaid, and/or SNP populations • Preferred: One year of SNP Care Management experience • Knowledge of CMS regulatory and contractual documents • Knowledge of Medicare Advantage, NCQA accreditation standards, disease management, utilization management, care management, and discharge planning • Excellent written and oral communication • Problem-solving capabilities • Attention to detail • Proficiency with Microsoft Office products • Ability to work under stressful conditions • Ability to meet defined deadlines and deliverables • Ability to stand and walk short distances for eight or more hours • Frequent bending, stooping, or stretching • Ability to lift 30 pounds and push 50 pounds