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!
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!