Transition of Care, Case Manager - CA RN

SCAN Health Plan; Long Beach (CA); On-site; USD 100,000 - 125,000; Full time

Job summary

Join a mission-driven organization dedicated to improving the health and independence of older adults. As a Transition of Care Case Manager, you will play a crucial role in ensuring seamless transitions from inpatient care to home settings. This position requires a strong clinical nursing background and the ability to develop personalized care plans that address the medical and psychosocial needs of members. You will work collaboratively with healthcare providers and families, providing education and support throughout the transition process. If you are passionate about making a difference in the lives of seniors and have the skills to manage complex care needs, this opportunity is perfect for you.

Benefits

Annual employee bonus program

Robust Wellness Program

Generous paid-time-off (PTO)

Excellent 401(k) Retirement Saving Plan

Employee recognition program

Remote Work Mode

Qualifications

• Strong background in clinical nursing focusing on transition of care.
• 3+ years of related experience in healthcare and care coordination.

Responsibilities

• Coordinate member transitions from inpatient settings to home care.
• Conduct clinical assessments and develop personalized care plans.
• Collaborate with healthcare providers and families for continuity of care.

Skills

Clinical Nursing

Care Coordination

Analytical Skills

Communication Skills

Motivational Interviewing

Problem Solving

Time Management

Bilingual (Spanish)

Education

Bachelor's Degree

California RN License

Certification in Case Management (CCM)

Certification in Care Transition (CCTM)

Tools

Electronic Medical Record (EMR)

Job description

Transition of Care, Case Manager - CA RN

Job Category: Medical Management

Requisition Number: TRANS006553

• Posted: November 7, 2024
• Full-Time

Locations

Showing 1 location

Remote role requires a current & active California RN License

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 277,000 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.

The Job

The purpose and ideal candidate will have a strong background in clinical nursing with a focus on transition of care activities from inpatient to home or other care settings. This role is pivotal in ensuring seamless care coordination and improving member outcomes by assessing, planning, implementing, coordinating, monitoring and evaluating the member’s health and psychosocial needs.

You Will

1. Coordinate and manage the transition of members from the inpatient (acute/skilled nursing facility) setting to home or other care settings for a 30-day program that starts at discharge.
2. Conduct comprehensive clinical assessments to develop personalized care plans and to identify any medical, physical, and psychosocial needs to prevent utilization/readmission and support member’s overall goals of care.
3. Ensure and evaluate clinical appropriateness of care plan by incorporating assessment findings against evidence-based guidelines, clinical reasoning, clinical practice guidelines and/or best practices in the community.
4. Collaborate with healthcare providers, members, and families/caregivers to ensure continuity of care and to ensure safe and appropriate transitions.
5. Provide education to members and families/caregivers with clear, concise, and culturally sensitive information about their health conditions, treatment plans, and post-discharge care.
6. Facilitate discussions about goals of care and end-of-life preferences when appropriate. Serve as the primary point of contact for members and families/caregivers during the transition period and monitor and follow up on member progress and outcomes post-discharge.
7. Comply with all regulatory and quality agency standards including: Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and accreditation bodies’ standards such as the National Commission of Quality Assurance (NCQA) as it relates to care transition activities.
8. All other duties as assigned.

Your Qualifications

1. Bachelor's Degree or equivalent experience.
2. California Registered Nurse (RN) license current & active.
3. Bilingual/Bicultural (Spanish) is a plus.
4. Certification in Case Management (CCM) or Care Transition (CCTM) is a plus.
5. 3+ years of related experience.
6. Technical expertise - Advanced analytical skills.
7. Problem Solving - Basic problem-solving skills.
8. Communication - Good communication and interpersonal skills.
9. Ability to interpret clinical data and make informed decisions regarding member care.
10. Ability to work from home independently.
11. Effective in managing multiple members and tasks while prioritizing urgent needs.
12. Knowledge and ability to use motivational interviewing to educate, support and motivate change during member contacts.
13. Exceptional verbal and written communication abilities to effectively interact with patients, families, and healthcare teams.
14. Demonstrates ability to effectively work with all stakeholders involved in member’s care.
15. Demonstrates the ability to document all phone calls and post-discharge evaluations and activities, including escalations and outcomes, in the Electronic Medical Record (EMR) in a timely manner that is viewable by key stakeholders.
16. Organizational and time management skills.

What's in it for you?

• Base salary range: $38.60 to $61.78 per hour
• Remote Work Mode
• Internal title - Medical Mgmt Spec-RN
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Excellent 401(k) Retirement Saving Plan with employer match and contribution
• Robust employee recognition program
• An opportunity to become part of a team that makes a difference to our members and our community every day!

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.