Care Manager – SNP

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• 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 • Liaise with the Interdisciplinary Care Team, PCP, and beneficiary/caregiver • Provide resources and benefits education to support self-management and quality of life • Collaborate with care management team members during transitions of care • Serve 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 and update activities and resources addressing member needs • Review medical records and documentation to ensure quality care • Investigate potential quality-of-care issues affecting member health or safety • Assist with quarterly reporting of delegated case management processes • Help members understand medical benefits and connect with in-network providers and community resources • Identify barriers to maximum quality of life • Perform virtual face-to-face visits when needed • Support compliance with CMS SNP Model of Care, NCQA standards, and Medicare Advantage regulations

🎯 Requirements

• Current Registered Nurse license issued by the state in which 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 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 working 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