Remote Care Manager: Lead Coordinated Elder Care

SCAN Group; United States; On-site; USD 98,636,160 - 158,010,720; Full time

Benefits offered by this job

Remote work

Annual bonus program

Wellness program

Paid time off

11 holidays + floating holiday + b-day

Job summary

SCAN Health Plan is seeking a Care Manager to coordinate care for members in collaboration with the Integrated Care Team, ensuring timely, high-quality care and appropriate facility placement.

This full-time role, remote, requires an Associate's degree or equivalent, 3-5 years of related experience, and a CA LVN license. You will apply evidence-based criteria, coordinate discharges, and support continuous care. We offer a robust benefits package.

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

Responsibilities

• 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.

Skills

Problem-Solving

Strong Communication

Detail oriented

Leadership / mentoring

Customer focus

Education

Associate's Degree or equivalent experience

CA LVN license

Job description

SCAN Health Plan is seeking a Care Manager to coordinate care for members in collaboration with the Integrated Care Team, ensuring timely, high-quality care and appropriate facility placement.

This full-time role, remote, requires an Associate's degree or equivalent, 3-5 years of related experience, and a CA LVN license. You will apply evidence-based criteria, coordinate discharges, and support continuous care. We offer a robust benefits package.