RN, Care Management

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 300,000 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

Enhance frail seniors' ability to age in place, manage their health, navigate the health care system, and live independently by providing person-centered care in accordance with care management, disease management, and complex and enhanced care management programs at SCAN. This individual will act as an integral part of the care team by working directly with members telephonically to develop and implement plans of care, provide health education and coaching to manage chronic conditions and prevent exacerbation of symptoms and prevent avoidable ER visits and hospital admissions.

You Will

Perform initial and annual telephonic assessments in conjunction with a Community Health Worker for Medi-Cal/Medicare dually eligible members referred to Care Coordination for Long-Term Services and Supports (LTSS) and in determining Nursing Facility Level of Care.

Perform nursing related Enhanced Care Management (ECM) activities related to specific Populations of Focus (POF): Individuals Experiencing Homelessness, Individuals At Risk For Avoidable Hospital Or ED Utilization, Adults Living In The Community At Risk Of LTC Institutionalization, Adult Nursing Facility Residents Transitioning Back To The Community.

Ensure the clinical appropriateness of member-centered care plans by evaluating assessment findings against evidence-based guidelines, clinical reasoning, and best practices. Integrate clinical insights and community standards to develop comprehensive and effective care strategies.  

Actively participates in interdisciplinary planning and case conference meetings to ensure person-centered care and to ensure member receives support following discharge from an inpatient or institutional setting.  Build strong working relationships with the Medical Groups team. 

Provide education, coaching, and disease management for chronic conditions by identifying new and preventable interventions to avoid exacerbations or worsening conditions.

Promote member engagement and patient activation to ensure optimal self-management for successful health outcomes.

Demonstrates organizational, decision-making, critical thinking, and multi-tasking skills as demonstrated by problem solving and achieving successful member outcomes. Adhere to all SNP Model of Care requirements and procedures. Complete timely and accurate documentation across multiple computer systems, including; care plans, service plans, and progress notes as necessary within established timeframes.

Completes timely and accurate documentation in multiple computer systems to complete assessment and corresponding documentation: care plans, service plans, authorizations, and progress notes as necessary.

Comply with all regulatory and quality agency standards including Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DHC), and Department of Health Care Services (DHCS).

Actively Adheres to all quality, compliance, and regulatory standards. 

We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

Actively support the achievement of SCAN’s Vision and Goals. 

Other duties as assigned.

Your Qualifications

Bachelor's Degree in Nursing required.

Registered Nurse (RN) License current & active required.

Graduate or Advanced Degree or equivalent experience.

3+ years managed care, health care environment and/or case management.

2+ years working with seniors and working remotely strongly preferred.

Bilingual Spanish strongly preferred. A test will be administered in bilingual.

Leadership - Skilled to develop others

Problem Solving - Make critical decision, often involving high-level risk assessment and the ability to adapt to changing circumstances

Strategic Mindset - Formulates strategy and maps steps to achieve strategic goals

Strong interpersonal skills, including excellent written and verbal communication skills.

Strong organizational skills.

Strong critical thinking skills.

Ability to multitask.

Ability to appropriately maintain confidentiality.

General understanding of NCAQ standards, CMS and DHCS regulations.

General knowledge of medical terminology and abbreviations.

Deep understanding of local community resources for seniors.

What's in it for you?

• Base salary range: $$44.42 to $63.51 per hour
• Work Mode - Remote (position will work Monday - Friday, 8am-5pm Pacific Time hours)
• 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.

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