Bilingual Care Manager - RN

Job Details

Description

Mostly Remote

About SCA

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 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 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.

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 appropriatedatabase.

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

Master’s degree in public health or registered nurse.

Current & active CA RN License required.

BILINGUAL- Must be bilingual in English/Spanish. (Test will be administered to assess proficiency.)

1 year of clinical nursing experience required.

3-5 years clinical experience with geriatric population (Acute, Ambulatory care, SNF and/or LTC) preferred.

Medicare/Medi-Cal experience in managed care environment preferred.

2+ years of case management experience in a medical group, IPA and/or HMO setting preferred.

Basic knowledge of related NCQA standards, CMS and DHCS regulations preferred.

5+ years of experience in healthcare, medical management, change management, and/or leadership preferred.

Navigate and access multiple software systems without error

Proficient in MS Office Suite (40 WPM)

Medical and clinical terminology conversant

Meets core competencies and clinical skills set for entry level

Excellent written and oral communication skills, as well as strong interpersonal, critical thinking and analytical skills

Excellent organizational, decision-making and multi-tasking skills

Demonstrates customer focus; proactively finds ways to exceed customer needs.

Demonstrates keen attention to detail and produces high quality work products.

Ability to prioritize multiple and competing tasks, work independently and in a team environment

Ability to work well in a fast-paced and dynamic environment

Knowledge and/or familiarity with the principles of project and program management.

Demonstrated ability to develop and implement new, replacement systems, and gain buy-in from appropriate audience.

Able to lead and influence those without direct ing relationships to achieve desired outcomes.

Ability to communicate with clarity, the vision, value, and tasks to formal and informal audiences.

Able to develop relationships quickly and leverage working relationships to drive performance outcomes.

Ability to work with all levels of staff, within and external to the organization to achieve goals.

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

Strong organizational skills; Ability to multitask and to appropriately maintain confidentiality.

What's in it for you?

• Base salary range: $38.61 to $61.78 per hour
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Ten paid holidays per year, plus 1 additional floating 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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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)