RN/LVN, SNP Telephonic Case Manager I - Full Time - Hourly - 100% Remote (after successful 90 day onsite completion)

Even during the COVID-19 pandemic, Desert Oasis Healthcare (DOHC) continued to receive recognition in 2020 for its company culture, as rated by its employees, and for service excellence, as rated by the local community. Not only was DOHC designated a Great Place to Work for the third consecutive year in 2020 but it also ranked #27 on the nationwide Fortune Best Workplaces in Health Care and Biopharma 2020 list. In addition, local readers voted DOHC Immediate Care Clinics as “Best of Desert 2020” in the Urgent Care category for its four locations in Palm Springs, Palm Desert, Indio, and Yucca Valley.

The Special Needs Plan (SNP) Telephonic Case Manager I is the entry level position of the SNP Telephonic Case Manager positions and is responsible for serving as a point of contact for assigned members and providing care coordination designated by Health Plan Special Needs Plans (SNP). The SNP Telephonic Case Manager I utilizing the SNP Model of Care for managing the medical, cognitive, psychosocial and functional needs of each assigned member through the development of an individualized care plan with the member. Each individualized member care plan is reviewed by the Interdisciplinary Care Team (ICT).

Maintain an average caseload of approximately 150-175 members. Achieve an overall audit-accuracy rating standard of 85% or better. Responsible for monitoring assigned Special Needs Plan (SNP) members, managing the member's healthcare conditions, prioritizing healthcare needs and educating the member in an effort to prevent complications and avoid utilizations. Educate the member on the importance of following up with their Primary Care Provider (PCP) regularly, the use of Immediate Care (IC) facilities, and the Case Manager as the single point of contact, in order to prevent unnecessary utilizations. Serious Illness Discussions and Life Planning, such as POLSTS and DPOAs will be discussed with members regularly, and will also routinely address the importance of preventative care and the need for appropriate follow-up with those Health Care Professionals rendering health care with focus on needed quality measures. Document using the Problem, Intervention, Plan (PIP) format, in the Electronic Health Record (EHR) in a timely manner. Documentation must comply with nursing standards, company policies and procedures and the requirements mandated by health plans, CMS and NCQA in order to meet routine audits. Completes the Clinical Social Assessment (CSA) annually on all assigned members. The Case Manager determines an acuity score for necessary follow-up. The Acuity Score – 1, 2, or 3 is determined by identifying the member’s medical and social needs. The CSA will be updated as health care needs and conditions change. After completing the CSA with the member and obtaining their input and agreement; the Case Manager develops an individualized plan of care with goals that are Specific, Measurable, Attainable, Realistic, and Time Bound (S.M.A.R.T.) which address the goals the member wishes to work on, to include a self-management, goal oriented individualized care plan. The Individualized Care Plan will be updated as necessary as health care needs and conditions change and or on an annual basis. Collaborate with other members of the Interdisciplinary Care Team (ICT) to meet the needs and plan of care for the members. Escalate issues and/or concerns to department management following the departmental chain of command. Perform other duties as assigned. Be an active listener (make eye contact, validate) Anticipate needs that will arise before your next meeting