What are the responsibilities and job description for the Transition of Care, Case Manager - CA RN position at SCAN and its subsidiaries?
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. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.
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
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.
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.
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.
Collaborate with healthcare providers, members, and families/caregivers to ensure continuity of care and to ensure safe and appropriate transitions.
Provide education to members and families/caregivers with clear, concise, and culturally sensitive information about their health conditions, treatment plans, and post-discharge care.
Educates and support member’s and families/caregivers focusing on seven primary areas: medication management, use of personal health record, follow up care, signs and symptoms of worsening condition, nutrition, functional needs and or Home and Community-based Services, and advanced healthcare directives.
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.
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.
All other duties as assigned.
Your Qualifications
Bachelor's Degree or equivalent experience.
California Registered Nurse (RN) license current & active.
Bilingual/Bicultural (Spanish) is a plus.
Certification in Case Management (CCM) or Care Transition (CCTM) is a plus.
3 years of related experience.
Technical expertise - Advanced analytical skills
Problem Solving - Basic problem-solving skills
Communication - Good communication and interpersonal skills
Ability to interpret clinical data and make informed decisions regarding member care.
Ability to work from home independently.
Effective in managing multiple members and tasks while prioritizing urgent needs.
Knowledge and ability to use motivational interviewing to educate, support and motivate change during member contacts.
Exceptional verbal and written communication abilities to effectively interact with patients, families, and healthcare teams.
Demonstrates ability to effectively work with all stakeholders involved in member’s care.
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.
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)
- Eleven paid holidays per year, plus 1 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!
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.
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Salary : $39 - $62
