Care Manager - LVN

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.The JobCoordinate care for members in collaboration with the Integrated Care Team, ensuring members are directed to the optimal facility for their needs and have all necessary services, supplies, and information. 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 WillServe as point of person to speak with patients, family members, and providers to address concerns pertaining to care, transfers and authorizations.Review patient’s clinical information and authorize requested medical services in a timely manner.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 while adhering to all policies and procedures. Issue determinations within required regulatory timeframes.Apply evidenced-based criteria and guidelines as well as clinical judgment and expertise to assess treatment plans.Manage member medical cases by applying the essential activities of care management and utilization management including assessment, planning, implementation, coordination, advocating, monitoring, and evaluation.Refer cases that do not meet established criteria to the Integrated Care physicians for secondary review.Review all acute/skilled nursing appeals and create detail explanation of non-coverage and reinstatement letters.Prepare, participate and facilitate high risk huddles and skilled nursing rounds. Maintain a list of high risk patients and conduct regular outreach calls to check on their health status.Coordinate timely delivery of last day cover letters to skilled nursing facilities.Coordinate discharge needs from inpatient acute settings and skilled nursing facilities as appropriate for each member. Discharge needs may include: durable medical equipment, home health services, specialist referrals, skilled nursing placement, transportation, and other needs.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.Coordinate direct admissions to skilled nursing facilities and direct ER transfers from senior living communities.Develop effective working relationships 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 with external stakeholders.Appropriately utilize Care Team administrative support resources, such as Integrated Care Delivery Care Management Coordinators, to ensure end to end coordination of care for members according to protocol, policy, and procedure.Actively support the achievement of SCAN’s Vision and Goals.This position is a patient-facing role.Employees may be eligible for differential pay.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.Other duties as assigned.Your QualificationsCA Licensed Vocational Nurse (LVN) required.Clinical nursing experience (2-4 years)Experience in care or utilization management (2+ years)5+ years of experience in healthcare, medical management, change management, and/or leadership.Ability to communicate effectively verbally and in writingHighly organized with attention to detailResourceful problem solverStrong interpersonal skills, hospitality, and change agent mindsetAdaptable and open to changeKnowledge and/or familiarity with the principles of project and program management.Demonstrated ability to develop and implement new, replacement systems, and gain buy-in from appropriate audience.Able to lead and influence those without direct reporting relationships to achieve desired outcomes.Ability to communicate with clarity, the vision, value, and tasks to formal and informal audiences.Able to develop relationships quickly and leverage working relationships to drive performance outcomes.Ability to work with all levels of staff, within and external to the organization to achieve goals.Strong interpersonal skills, including excellent written and verbal communication skills.Strong organizational skills; Ability to multitask and to appropriately maintain confidentiality.What’s in it for you?Base salary range: $34.47 to $55.14 per hourRemote Work ModeAn annual employee bonus programRobust Wellness ProgramGenerous paid-time-off (PTO)Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holidayExcellent 401(k) Retirement Saving Plan with employer match and contributionRobust employee recognition programTuition reimbursementAn 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.#LI-BB1Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c) #J-18808-Ljbffr Scan-Health-Plan