Bilingual Spanish RN Case Manager | Medicare Special Needs Program (SNP) | Remote | Active California RN License Required (Non-Compact)

GENERAL DUTIES / RESPONSIBILITIES

• 1. Coordinates care by serving as a resource for the member, their family, and their physician. 2. Ensures access to appropriate care for members with urgent or immediate needs facilitating referrals/authorizations within the benefit structure as appropriate. 3. Completes comprehensive assessments within their scope of practice that includes assessing the member's current health status, resource utilization, past and present treatment plan, and services. 4. Collaborates with the member, the PCP, and other members of the care team to implement a plan of care. 5. Interfaces with Primary Care Physicians, Hospitalists, Nurse Practitioners, and specialists on the development of care management treatment plans. 6. Provides education and self-management support based on the member’s unique learning style. 7. Assists in problem solving with providers, claims or service issues. 8. Works closely with delegated or contracted providers, groups, or entities to assure effective and efficient care coordination. 9. Maintains confidentiality of all PHI in compliance with state and federal law and Alignment Healthcare Policy.
• Supervisory responsibilities:

Experience

Education

Specialized Skills

• Required:
• Possess a high level of understanding of community resources, treatment options, home health, funding options and special programs
• Extensive knowledge of the management of chronic conditions Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Ability to operate PC-based software programs including proficiency in Word, Excel and PowerPoint
• Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
• Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Report Analysis Skills: Comprehend and analyze statistical reports.

Licensure

Requirements

• Required:
• Possess a high level of understanding of community resources, treatment options, home health, funding options and special programs
• Extensive knowledge of the management of chronic conditions Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Ability to operate PC-based software programs including proficiency in Word, Excel and PowerPoint
• Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
• Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Report Analysis Skills: Comprehend and analyze statistical reports.