Bilingual Spanish RN, Care Management

SCAN Health Insurance • Los Angeles, CA

6d • $44 - $61 • Remote

About The Position

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. Job Description: Field position with 80% travel in & around Los Angeles County CA RN required - M-F 8am-5pm Pacific Time work hours The Job Enhance frail seniors' ability to age in place, manage their health, navigate the health care system, and live independently by providing person-centered care in accordance with care management programs at SCAN. This individual will act as an integral part of the team by working directly with members telephonically and in their homes to triage and assess member needs, resolve immediate access issues, make recommendations to healthcare providers, and ensure appropriate referrals to benefits, resources, and services as needed. You Will Provide timely assessment and triage and resolution of complex medical/clinical issues, safety or access issues or special programs. Provide longitudinal care management which includes coaching, education, navigation, physical assessment, recommendations to PCPs, and referrals to community- based resources. Promote member engagement and patient activation to ensure optimal self-management for successful health outcomes. Demonstrates organizational, decision-making, critical thinking, and multi-tasking skills as demonstrated by problem solving and achieving successful member outcomes. Adhere to all SNP Model of Care requirements and procedures. Complete timely and accurate documentation across multiple platforms, including care plans, service plans, and progress notes as necessary within established timeframes. Completes timely and accurate documentation in multiple platforms to complete assessment and corresponding documentation: care plans, service plans, authorizations, and progress notes as necessary. Comply with all regulatory and quality agency standards including Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DHC), and Department of Health Care Services (DHCS). Delegate to other members of the care team as appropriate as the leader of a care management pod structure. Assess environmental safety in conjunction with other members of the healthcare team. We seek Rebels who are curious about AI and its power to transform how we operate and serve our members. Actively support the achievement of SCAN’s Vision and Goals. Other duties as assigned.

Requirements

• Bachelor's degree in nursing (BSN) required.
• CA Registered Nurse (RN) required.
• BILINGUAL required in English/Spanish. (Test will be administered to assess proficiency if applicable.)
• 3+ years managed care, healthcare environment, or case management.
• Strong interpersonal skills, including excellent written and verbal communication skills.
• Strong organizational skills.
• Strong critical thinking skills.
• Ability to multitask.
• Ability to appropriately maintain confidentiality.
• General understanding of NCQA standards, CMS and DHCS regulations.
• General knowledge of medical terminology and abbreviations.
• Deep understanding of local community resources for seniors.
• Travel 80+% of the time in the Los Angeles County area (CA).
• Must have a valid driver’s license, automobile insurance and reliable transportation.

Nice To Haves

• Graduate or Advanced Degree or equivalent experience preferred.
• Certified Case Manager preferred.
• 2+ years working with seniors and working remotely strongly preferred.
• Leadership - Skilled to develops others Problem Solving - Make critical decisions, often involving high-level risk assessment and the ability to adapt to changing circumstances Strategic Mindset - Formulates strategy and maps steps to achieve strategic goal

Responsibilities

• Provide timely assessment and triage and resolution of complex medical/clinical issues, safety or access issues or special programs.
• Provide longitudinal care management which includes coaching, education, navigation, physical assessment, recommendations to PCPs, and referrals to community- based resources.
• Promote member engagement and patient activation to ensure optimal self-management for successful health outcomes.
• Demonstrates organizational, decision-making, critical thinking, and multi-tasking skills as demonstrated by problem solving and achieving successful member outcomes.
• Adhere to all SNP Model of Care requirements and procedures.
• Complete timely and accurate documentation across multiple platforms, including care plans, service plans, and progress notes as necessary within established timeframes.
• Completes timely and accurate documentation in multiple platforms to complete assessment and corresponding documentation: care plans, service plans, authorizations, and progress notes as necessary.
• Comply with all regulatory and quality agency standards including Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DHC), and Department of Health Care Services (DHCS).
• Delegate to other members of the care team as appropriate as the leader of a care management pod structure.
• Assess environmental safety in conjunction with other members of the healthcare team.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Benefits

• Remote/field position
• 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!

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level