This role is full-time and will provide coverage during non-business hours to ensure continuity of care. The JobThe Care Manager will coordinate care for members in collaboration with the Integrated Care Team, ensuring members receive high-quality, timely, and coordinated care, are directed to the optimal facility for their needs, and have all necessary services, supplies, and information. The Care Manager authorizes services based on well-developed knowledge and skills in areas of utilization management, medical necessity, and patient status determination. Conducts pre-service and concurrent review following established guidelines. Applies care management principles and practices to ensure medical needs, care, and service are coordinated.
You Will- Serve as point person to speak with patients, family members, and providers to address concerns pertaining to care, transfers and authorizations
- Ensure necessary inpatient and outpatient care or other services are rendered to SCAN members at the right time, the right level of care and at the right location, with end-to-end coordination, while adhering to all policies and procedures
- Coordinate discharge needs from inpatient acute settings and skilled nursing facilities as appropriate for each member.
- Coordinate timely delivery of last cover day letters to skilled nursing facilities
- Discharge needs may include: durable medical equipment, home health services, specialist referrals, skilled nursing placement, transportation, and other needs Issue determinations within required regulatory timeframes
- Apply evidenced-based criteria and guidelines, as well as clinical judgment and expertise, to help develop treatment plans
- Review tasks assigned by Integrated Care Nurse Practitioners and coordinate member care accordingly, including services such as: home health; DME ordering, wound care, Foley catheter, Enteral, colostomy supplies, infusion orders and outpatient services
- Review all acute/skilled nursing appeals and create detail explanation of non-coverage and reinstatement letters
- Refer cases that do not meet established criteria to the Medical Directors for secondary review
- Prepare, participate and facilitate high risk huddles and/or skilled nursing rounds Maintain a list of high risk patients and conduct regular outreach calls to check on their health status
- Develop effective working relationships and collaboration with and provide clinical guidance to Care Coordinators on clinical matters.
- Demonstrate excellent organizational, decision-making and multi-tasking skills as demonstrated by problem-solving and successful outcomes
- Promote the mission, vision, and values of SCAN Health Plan and serve as an ambassador when interfacing and collaborating with external stakeholders, including contracted medical groups and vendors.
- Other duties as assigned.
- Actively support the achievement of SCAN's Vision and Goals.
- We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
Your Qualifications- Associate's Degree or equivalent experience
- 3-5 years of related experience
- CA LVN license
- Performs work under direct supervision .
- Handles basic issues and problems, and refers more complex issues to higher-level staff
- Possesses beginning to working knowledge of subject matter.
- Provides leadership, coaching, and/or mentoring to partner care coordinators.
- Technical Expertise
- Problem-Solving
- Strong Communication
- Customer/client focused
- Detail oriented
- Responsible
What's in it for you?- Base salary range: $34.47 to $55.14 per hour
- Work Mode: Remote
- Annual bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- Eleven paid holidays per year, plus 1 additional 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!
