*CA RN Required
*Position will work Pacific Time Business Hours
About SCAN
SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.
The Job
The purpose of the Care Manager - RN is to collaboratively assess and evaluate the member’s physical health, mental health and psychosocial needs to determine eligibility for long-term services and supports (LTSS). Conducting initial and annual Nursing Facility Level of Care (NFLOC) assessments in collaboration with the Field Care Managers and using expert knowledge of Title 22 criteria, these nurses develop individualized care plans based on the SCAN Special Needs Plan (SNP) Model of Care (MOC). These processes promote quality and cost-effective interventions and ensure members receive their appropriate benefits.
You Will
Assesses members to identify medical, physical and psychosocial needs via telephonic NFLOC assessments with Connections members subsequent to Field Care Manager home visits for in-home psychosocial assessment (determine eligibility for LTSS) to ensure that member meets eligibility criteria based on CA Title 22.
Conducts annual telephonic NFLOC assessments with Connections at Home members to ensure member continues to meet the eligibility criteria based on CA Title 22.
Ensures appropriate assessments and care plans for this population are completed according to SCAN SNP MOC, state and federal regulations and SCAN policies and desktop procedures.
Collaborates with the Field Care Manager staff to ensure all information is gathered and consistent to determine member’s eligibility and unmet LTSS and case management needs.
Provides coaching, education and care management during the assessment and if specific criteria is met, initiate referral to complex care management (internal at SCAN or to delegated medical group, depending on contract).
Ensures and evaluates clinical appropriateness of care plan, by evaluating assessment findings against evidence based guidelines, clinical practice guidelines and/or nationally developed guidelines for development of an appropriate plan of care based on individual needs and findings and including physical, psychological, social and spiritual factors that may influence member health status and eligibility in conjunction with the interdisciplinary team.
Facilitates care coordination across the care continuum (home, hospital, home health, or nursing facility), identifies community resources and makes referrals as appropriate.
Educates and counsels member about health prevention guidelines and disease states using SCAN approved evidence-based guidelines.
Promotes member activation and engagement to ensure optimal self-management skills and health outcomes.
Documents accurate and complete data for all member contacts in the appropriate database.
Enhances department and organization reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
Actively participates in staff meetings, educational offerings and interdisciplinary team meetings.
Complies with all regulatory and quality agency standards including: Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), California Department of Health Care Services (DHCS), and accreditation bodies’ standards such as the National Commission of Quality Assurance (NCQA) as it relates to care management activities; serves as a resource for other departments.
Addresses and follows-up with all identified member quality concerns using approved processes.
Utilizes department desktop procedures, workflows, job aids and training material. Identifies barriers to work processes and brings to the attention of the supervisor/manager.
Maintains the member‘s right to privacy and protects SCAN operations by keeping information confidential.
Contributes to team effort by accomplishing related results as needed.
Actively support the achievement of SCAN’s Vision and Goals.
Other duties as assigned.
Your Qualifications
CA RN License required.
At least 1 year Clinical Nursing experience required.
Working experience with strong customer service; will work with Members and internal teams by phone, email, teams, etc.
3+ years clinical experience with geriatric population (Acute, Ambulatory care, SNF and/or LTC).
Medicare/Medi-Cal experience in managed care environment.
2+ years of case management experience in a medical group, IPA and/or HMO setting.
Basic knowledge of related NCQA standards, CMS and DHCS regulations.
What's in it for you?
- Base salary range: $38.60 to $61.78 per hour
- An annual employee bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
- Excellent 401(k) Retirement Saving Plan with employer match and contribution
- Robust employee recognition program
- Tuition reimbursement
- An opportunity to become part of a team that makes a difference to our members and our community every day!
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.
SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
#LI-CS2
#LI-Remote
