3 Case Manager, SNP Tele II Jobs in Palm Springs, CA
Desert Oasis Healthcare is Hiring a Case Manager, SNP Tele II Near Palm Springs, CA
- Responsible for telephonically monitoring Special Needs Plan (SNP) members by managing and educating them about healthcare conditions and prioritizing their healthcare needs, in order 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.
- Will document effectively using the Problem, Intervention, Plan (PIP) format, in the Electronic Health Record (EHR) in a timely manner. This 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.
- Complete 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.
- Collaborates with other members of the Interdisciplinary Care Team (ICT) to meet the needs and plan of care for the members.
- Actively seeks supervisory assistance by following the established Chain of Command.
- Maintain a caseload of approximately 175 - 200 members.
- Achieve an overall audit-accuracy rating standard of 90% or better.
- Serves as a mentor/resource for newly hired case managers.
- Perform other duties as assigned.
- Completion of an accredited nursing program. Current California Licensed Vocational Nurse (LVN) or Registered Nurse (RN) License.
- Three years of acute care or Skilled Nursing Facility experience, preferred.
- Strong medical knowledge and competence in chronic disease pathophysiology, polypharmacy, clinical assessment, and patient-family education.
- Excellent oral and written communication skills, conflict resolution, and time management and negotiation skills. Basic computer skills required.
- Ability to work independently with a minimum of direction on a high volume caseload environment and deal effectively with rapidly changing priorities. Ability to anticipate/organize workflow, prioritize and follow through on responsibilities.
- Positive interpersonal, influencing and decision making skills. Ability to work constructively with a broad spectrum of health care professionals, ability to work respectfully and creatively with members of diverse functional abilities, social, economic, and cultural backgrounds to support both member autonomy and member safety.
- Bilingual preferred but not required. Ability to speak, read and write in English and Spanish fluently, preferred.
- At the discretion of DOHC/FHC management, this position has the potential to be a full or hybrid telecommuting position.
Job Summary
Full Time
Ambulatory Healthcare Services
$77k-93k (estimate)
08/10/2023
06/27/2024
mydohc.com
INDIO, CA
200 - 500
1981
RANDY VAUGHN
$10M - $50M
Ambulatory Healthcare Services
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About Desert Oasis Healthcare
Desert Oasis Healthcare is committed to the provision and facilitation of the highest quality medical care to the residents of the desert communities. We will strive to be an organization which provides excellence in every encounter. As a result, we will be recognized by: Our patients as their care givers of choice; Our employees as their employer of choice; Our provider and health plan partners as their health care network of choice. Desert Oasis Healthcare is a non-discriminate (Religious, Cultural, Sexual, Ethnic) Health Care Provider. In 1981, Desert Medical Group Inc. introduced to the Co...achella Valley a full service medical facility, providing the community with all their health care needs from newborn to senior care. Today, we are Desert Oasis Healthcare - a team of highly skilled primary care physicians and ancillary providers with services conveniently located throughout the desert communities. Our many locations include Palm Springs, Bermuda Dunes, Indio, Rancho Mirage and Yucca Valley. Desert Oasis Healthcare's services include access to 4 Immediate Care Centers - Indio, Palm Desert, Palm Springs and Yucca Valley. We also offer an award winning Outreach Services Department that is committed to educating individuals on how to apply the principles of preventative health care in their daily lives, resulting in improved health. Desert Oasis Healthcare accepts most HMO's, private insurance, Medicare and private pay patients. We are affiliated with every hospital in the Coachella Valley, which includes Eisenhower Memorial Hospital, Desert Regional Medical Center, John F. Kennedy Memorial Hospital and Hi-Desert Medical Center
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