Special Need Plan Program Supervisor

GENERAL DESCRIPTION:

The Special Needs Plan (SNP) Program Supervisor oversees the daily operations and performance of the SNP Program to ensure compliance with organizational policies, regulatory requirements, and program objectives. This position monitors clinical processes, conducts oversight activities, and implements operational strategies that support eligibility validation for Special Supplemental Benefits for the Chronically Ill (SSBCI), Chronic Condition Special Needs Plans (C-SNP), and other applicable SNP initiatives. The role also supervises the administration of Individualized Care Plans (ICPs) and the Alternative Interdisciplinary Care Team (Alternative ICT), ensuring timely care coordination, interdisciplinary collaboration, and beneficiary-centered service delivery.
Regular
Exempt
ESSENTIAL FUNCTIONS:

Monitors the Unit's operational processes to ensure compliance with Company policies, procedures, and applicable regulatory requirements.
Implements, audits, and reports on the Unit's work plan, processes, and initiatives to ensure compliance with established goals, performance expectations, and operational standards.
Audits the chronic condition validation process to ensure appropriate enrollment in Chronic Condition Special Needs Plans (C-SNP). Audits and monitors the validation of eligibility for Special Supplemental Benefits for the Chronically Ill (SSBCI) through Health Risk Assessments (HRAs) and organizational determinations, ensuring compliance with established policies and procedures.
Supervises and audits the Individualized Care Plan (ICP) monitoring process for the C-SNP population to ensure compliance with organizational policies, procedures, and regulatory requirements.
Supervises the continuity and effectiveness of communication between the Individual Care Plan Specialist (Non-Clinical) and the Mailing Specialist to support timely and accurate care plan administration.
Coordinates and collaborates in the preparation of presentations, reports, and supporting materials for the Alternative Interdisciplinary Care Team (Alternative ICT), ensuring information is accurate, timely, comprehensive, and aligned with operational, clinical, and regulatory requirements.
Develops operational guidelines, workflows, and supporting documentation, including emails, one-pagers, flowcharts, and reference guides, to support process execution and operational consistency.
Prepares and reports care plan metrics related to initiatives for vulnerable populations, including Dual Eligible Special Needs Plans (D-SNP) and Chronic Condition Special Needs Plans (C-SNP), within established reporting deadlines.
Supervises, monitors, trains, evaluates, and corrects personnel among others to comply with his/her role as a supervisor, to assure that his/her personnel fulfill their work plan and comply with their essential functions and that they behave following the policies, standards, norms, and procedures of the Company.
Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
MINIMUM QUALIFICATIONS:

Education and Experience:

Bachelor’s degree in nursing sciences. At least five (5) years of experience working with clinical programs in an environment of care, health services, and/or clinical case management, including at least two (2) years of experience supervising staff.
Certifications/Licenses:

A valid Nurse & Association Nursing Professionals of Puerto Rico License and Registration is required.
Other:

Must be available to work a rotating schedule, including weekends and holidays, as required to meet operational and business needs.
Languages:

Spanish – Advanced (comprehensive, writing and verbal)
English – Intermediate (comprehensive, writing and verbal)
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