[Hiring] RN, Care Management @SCAN Health Insurance

Role Description

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.

• 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 participate 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.
• Demonstrate 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.
• 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 adhere to all quality, compliance, and regulatory standards.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Qualifications

• Associate's degree in nursing (ASN) required.
• Bachelor's degree in nursing (BSN) strongly preferred.
• Graduate or Advanced Degree preferred.
• CA Registered Nurse (RN) required.
• BILINGUAL English/Spanish preferred. (Test will be administered to assess proficiency if applicable.)
• 3+ years managed care, healthcare environment, or case management.
• 2+ years working with seniors and working remotely strongly preferred.
• Leadership - Skilled to develop others.
• Problem Solving - Make critical decisions, 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 NCQA standards, CMS and DHCS regulations.
• General knowledge of medical terminology and abbreviations.
• Deep understanding of local community resources for seniors.

Benefits

• This is a temporary opportunity for a limited period of time.
• Base Pay Range: $50-55 per hour.
• Work Mode: Remote.
• Medical Benefits.
• Paid Sick Time.
• Excellent 401(k) Retirement Saving Plan.
• Robust employee recognition program.
• An opportunity to become part of a team that makes a difference to our members and our community every day!