(Archived) Manager, Case Management SNP (Must Have RN License in California + 2 years of Supervisor Experience)

*****Must Have Current, Active, and Unrestricted Registered Nursing license in California*****

*****2+ years of supervisory experience in a health plan setting*****

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

Position Summary:

The SNP team is responsible for the health care management and coordination of care for members with complex and chronic care needs. The SNP Manager assures compliance with SNP program requirements as outlined in the Model of Care. This includes the monitoring of activities to support the timeliness of Health Risk Assessment (Initial and Reassessment) completion, Individualized Care Plan (ICP) development and Interdisciplinary Care Team (ICT) delivery for SNP members.

The SNP Manager is responsible for monitoring and reporting program performance, including vendor performance monitoring if activities are delegated. The SNP Manager reports directly to the SNP Program Director and supports the Director by providing program reporting, timely and consistent feedback on service, quality, and performance goals.

Essential to the SNP Manager role is contributing to the success of the company. The manager’s actions should be poised toward business growth and comply with Alignment policies. The manager will collaborate with the department Director and upper management team to promote successful growth within the department and throughout the company.

This position is responsible for the day-to-day operational performance of an integrated health management team while ensuring high-quality care management and adherence to regulatory and compliance standards for the appropriate program lines of business.

The SNP Manager is responsible for functions for the Special Needs Plan (SNP) membership as defined below:

General Duties/Responsibilities (May include but are not limited to):

· Oversees operational reports to assist the Director in managing SNP performance and ensuring compliance with CMS requirements.

· Reviews reports on program performance identify reporting opportunities and gaps to ensure the effective delivery of the SNP program.

· Participates in SNP quality audits, including CMS program audits and vendor audits to assess the timeliness of SNP activities.

· Reports audit results and identifies opportunities for process improvements

· Effectively communicates and keeps Director of Care Management informed of all departmental operations, activities, data, program performance, issues, or any other pertinent information that would impact the over-program compliance or achievement of internal goals.

· Assists with patient tracking, data reporting, and vendor management

· Directs or oversees appropriate routing or assignment of cases, monitors volume and complexity of cases to ensure a balanced distribution of caseloads and adequate staffing.

· Manages and leads the overall case management activities and day-to-day operations of the team.

· Evaluates policies and workflows for efficiencies and make necessary changes to diminish risk and enhance process improvements.

· Manages the design, development, implementation, and maintenance of projects/processes related to case management initiatives that may encompass multiple departments.

· Coaches, mentors, and holds staff accountable to assure that department and performance goals and objectives are met.

· Conducts performance audits and manages personnel and performance issues according to AHP policies and procedures

· Conducts quality reviews. Reports audit results and identify opportunities for staff development and process improvements to designated management and committee

· Ability to perform all functions within the Case Management department and acts as a working manager to support the team and new business initiatives as needed.

· Ability to analyze data and recommend strategies for pilots, projects, and trends for case management initiatives. Demonstrated ability to manage projects resulting in desired outcomes.

· Collaborates with UM, CM, HEDIS/STARs, and other AHP programs and departments to facilitate optimal program integration and continuity of care.

· Maintains confidentiality of information between and among health care professionals

· Performs other duties as required in a competent, professional, and courteous manner.

SUPERVISORY RESPONSIBILITIES:

Oversees assigned staff. Responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Experience:

a. 5+ years of clinical case management experience or any combination of education and experience would provide an equivalent background.

b. 2+ years of supervisory experience in a health plan setting.

c. SNP experience in a health plan setting

Education/Licensure:

a. Current, Active, and Unrestricted Registered Nursing license in the state you are applying; Certification preferred.

b. BSN / MSN degree (preferred)

Other:

a. Knowledge of Medicare Managed Care Plans

b. Knowledge of MCG criteria/Utilization functions

c. Demonstrated leadership skills

d. Ability to manage projects/initiatives to improve program performance

e. CCM preferred

f. Good oral, written, and telephone skills.

g. Computer Skills: Basic skills required.

h. Good organizational skills

i. Ability to reason and carry out instructions.

j. Good interpersonal skills.

k. Read, write and speak English fluently.

Work Environment

a. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands 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 individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

On August 17, 2021, Alignment implemented a policy requiring all new hires to receive the COVID-19 vaccine. Proof of vaccination will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations. This policy is part of Alignment’s ongoing efforts to ensure the safety and well-being of our staff and community, and to support public health efforts.