RN, Care Management (Riverside)

SCAN Health Insurance•Riverside, CA

8d•$44 - $61•Hybrid

About The Position

The Registered Nurse (RN) – Care Management is a clinically accountable role responsible for delivering high-touch, person-centered care management to members with complex medical needs who cannot be effectively supported through telephonic care management alone. The RN conducts in-home and telephonic assessments, develops and manages individualized care plans, educates members and caregivers on disease processes and self-management, and collaborates with an interdisciplinary care team to stabilize risk and improve health outcomes. The RN serves as the clinical lead, coordinating care across providers and settings to promote safe, effective, and timely care. 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.
3+ years clinical experience in care management, case management, home health, community-based care, or a related clinical setting preferred.
2+ years working with seniors and hybrid remotely strongly preferred.
Experience working with high-risk, complex, or chronically ill populations 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

Graduate or Advanced Degree or equivalent experience preferred.
BILINGUAL preferred in English/Spanish. (Test will be administered to assess proficiency if applicable.)

Responsibilities

Conduct comprehensive clinical, functional, and environmental assessments in members’ homes and via telephonic encounters, based on clinical risk and acuity.
Identify clinical, functional, medication, caregiver, and environmental risks that may impact member stability or safety.
Work collaboratively with Social Workers, Community Health Workers, Care Coordinators, and other interdisciplinary team members to address medical, psychosocial, and environmental barriers to health.
Participate in case reviews, huddles, and interdisciplinary discussions to support coordinated, member-centered care.
Develop, implement, and regularly update individualized care plans with measurable goals focused on member priorities and health outcomes by evaluating assessment findings against evidence-based guidelines, clinical reasoning, and best practices.
Integrate clinical insights and community standards to develop comprehensive and effective care strategies.
Provide disease-specific education, coaching, and self-management support to members and families, using teach-back to confirm understanding.
Support medication safety through medication reconciliation, adherence assessment, and coordination with providers and pharmacy resources when needed.
Coordinate care with primary care providers, specialists, hospitals, skilled nursing facilities, home health, and community resources to ensure continuity of care.
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.
Manage transitions of care following emergency department visits, hospitalizations, or facility discharges, including follow-up, risk mitigation, and education on red-flag symptoms.
Comply with all compliance, 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)
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, Documented Dementia, Serious Mental Illness (SMI) & Substance Use Disorder (SUD)

Benefits

Base salary range: $44.42 to $61.20 per hour
Work Mode: Hybrid
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!
A competitive compensation and benefits program
Excellent Retirement Savings program
A work-life balance