Case Management Nurse (RN/LPN)

Vantage Health Plan, Inc.
Published
January 12, 2021
Location
Atlanta, GA
Category
Job Type

Description

At Vantage Health Plan, Inc. , 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).


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

Marginal Duties:

• Participate on the QI Committee, Case Management Committee, and SNP Quality Committee

• Other duties as assigned

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