RN, Care Management

SCAN Health Plan • Los Angeles, CA

1d • Remote

About The Position

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity. At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve. CA RN Required. Position will work Pacific Time Business 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, disease management, and complex and enhanced care management programs at SCAN. This individual will act as an integral part of the care team by working directly with members telephonically to develop and implement plans of care, provide health education and coaching to manage chronic conditions and prevent exacerbation of symptoms and prevent avoidable ER visits and hospital admissions.

Requirements

• Associate's degree in nursing (ASN) required.
• CA Registered Nurse (RN) required.
• 3+ years managed care, healthcare environment, or case management.
• 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
• 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.

Nice To Haves

• Bachelor's degree in nursing (BSN) preferred.
• Graduate or Advanced Degree preferred.
• BILINGUAL English/Spanish. (Test will be administered to assess proficiency if applicable.)

Responsibilities

• Perform initial and annual telephonic assessments in conjunction with a Community Health Worker for Medi-Cal/Medicare dually eligible members referred to Care Coordination for Long-Term Services and Supports (LTSS) and in determining Nursing Facility Level of Care.
• Perform nursing related California Integrated Care Management (CICM) activities related to specific Populations of Focus (POF): Individuals Experiencing Homelessness, Individuals At Risk For Avoidable Hospital Or ED Utilization, Adults Living In The Community At Risk Of LTC Institutionalization, Adult Nursing Facility Residents Transitioning Back To The Community.
• Ensure the clinical appropriateness of member-centered care plans based on assessment against evidence-based guidelines, clinical reasoning, and best practices.
• Integrate clinical insights and community standards to develop comprehensive and effective care strategies.
• Actively collaborate in interdisciplinary planning and case conference meetings to ensure person-centered care and to ensure member receives support following discharge from an inpatient or institutional setting.
• Build strong working relationships with the Medical Groups team.
• Provide education, coaching, and disease management for chronic conditions by identifying new and preventable interventions to avoid exacerbations or worsening conditions
• 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 computer systems, including; care plans, service plans, and progress notes as necessary within established timeframes.
• Completes timely and accurate documentation in multiple computer systems 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)
• Actively support the achievement of SCAN's Vision and Goals.
• Other duties as assigned.

Benefits

• Base salary range: $44.42 to $61.20 per hour
• 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
• Education Level: Associate degree