At Vantage Health Plan, we specialize in taking care of people: our members, our patients, and our employees. We offer competitive salaries and great benefits! Benefits include: Health, Dental, Life, Accidental Death and Dismemberment, Long Term Disability, Paid Time Off, and 401(k).
Vantage is currently looking for a SNP Case Management Nurse to work from 8:00AM – 5:00PM, Monday through Friday.
Job Summary : Vantage Health Plan’s Special Needs Plan is an All Dual Eligible Special Needs Plan (D-SNP) providing focused care for members that have Medicare and are also entitled to Medicaid. The SNP Case Management Nurse is responsible for conducting telephonic case management, care coordination, and quality activities to ensure quality of care is maintained as the patient accesses care and services in the continuum of care. The SNP Case Management Nurse will work in collaboration with the member, the member’s care providers, and a multi-disciplinary team, employing a variety of strategies, approaches and techniques to manage the member’s physical, environmental, and psycho-social health needs.
Essential Duties & Responsibilities:
• Adhere to Special Needs Plan Model of Care program goals and objectives to meet the member’s individualized health care needs through adherence to program policies and procedures
• Actively participate in all enrollment activities
• Perform telephonic case management and care coordination activities, communicating with the multidisciplinary team
• Review each case individually and evaluates for referral to Social Services, Behavioral Health, Disease Management, community resources and other resource needs
• Collect pertinent clinical information (including claims data when available), documenting findings using the Acuity case management system
• Evaluate and complete the Health Risk Assessment which includes physical, psychological, emotional and environmental assessments, for the purpose of providing appropriate, timely interventions to ensure provision of optimal care
• Coordinate community care and services as deemed appropriate
• Develop an individualized care plan for each member along with the member and/or family and through collaboration with the Interdisciplinary Care Team (ICT)
• Provide ongoing evaluation and management of the member’s progress, effectiveness of the care plan, as well as, the efficacy and appropriateness of services provided
• Work collaboratively with other members of the VantageCare Interdisciplinary Care Team to include: Vantage Case Managers, Social Services, Field Care Managers, Transitional Care, Behavioral Health and providers including the members’ Physician(s) and other healthcare providers
• Consult and collaborate with the Medical Director of Case Management as needed regarding member cases related to appropriateness of care, evidenced based clinical guidelines, medications and other treatment plans, individualized care plans and resource needs required to meet/manage the member’s level of care
• Comply with performance and reporting standards as defined by Vantage Health Plan and CMS
• Participate on the QI Committee, Case Management Committee, and SNP Quality Committee
• Other duties as assigned
Knowledge, Skills, and Abilities:
• Graduate of an accredited school of Nursing with current unrestricted license to practice as an RN in Louisiana
• Minimum of 3 years of general clinical experience required
• Minimum of 1 year of clinical experience in case management, acute hospital discharge planning, or utilization review
• Previous direct clinical care to patients in a behavioral health setting preferred
• Current Case Management Certification preferred
• Excellent verbal and written communication skills
• Excellent phone etiquette required
• Ability to use Microsoft Office Suite (Excel, Word, Power Point, etc.)
• Highly organized and efficient with strong attention to detail
• Ability to travel to other clinics and/or educational trainings
• Ability to work under limited supervision and to make decisions based on established policies and procedures
• Ability to interact effectively with all levels of staff
• Works under general supervision of the Case Management Supervisor
• This position operates in a professional office environment
• This is a full-time position (40 hours/week)
• Overtime may be required
• Travel may be required
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to satisfactorily perform these essential functions without causing an undue hardship for the employer.
While performing the duties of this job, the employee is required to remain in a stationary position for long periods of time and must frequently move about the office. The employee must constantly operate a computer and other office equipment such as phones, keyboards, printers, and copiers. The employee is regularly required to communicate with others via phone, email, etc. Occasionally, the employee is required to move up to 10 pounds and may, at times, be required to move up to 50 pounds.
Attention To Detail