RN Care Management(Remote)

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." 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. 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. 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.

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.

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).

We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

Associate's degree in nursing (ASN) required.

Bachelor's degree in nursing (BSN) preferred.

Graduate or Advanced Degree preferred.

CA Registered Nurse (RN) required.

BILINGUAL English/Spanish. (3+ years managed care, healthcare environment, or case management.

2+ years working with seniors and working remotely strongly preferred.

Problem Solving - Make critical decisions, often involving high-level risk assessment and the ability to adapt to changing circumstances

General understanding of NCQA standards, CMS and DHCS regulations.

General knowledge of medical terminology and abbreviations.

Deep understanding of local community resources for seniors.

44.42 to $61.20 per hour

Work Mode: Mostly Remote. Employees who reside outside the local area are expected to work remotely and travel to SCAN's headquarters approximately once per month for in-person meetings, team collaboration, training, and other business needs. SCAN's headquarters is currently located in Long Beach, California, and is expected to relocate to Cerritos, California, in 2027.

An annual employee bonus program

Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday

Excellent 401(k) Retirement Saving Plan with employer match and contribution

Tuition reimbursement

An opportunity to become part of a team that makes a difference to our members and our community every day!

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.

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. Equal Opportunity Employer/Protected Veterans/Individuals With Disabilities
The 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.