Care Manager - LVN

This role is full-time and will provide coverage during non-business hours to ensure continuity of care. The Job The 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!