Care Manager - LVN

This role is full-time and will provide coverage during non-business hours to ensure continuity of care. The Job The Care Manager will coordinate care for members in collaboration with the Integrated Care Team, ensuring members receive high-quality, timely, and coordinated care, are directed to the optimal facility for their needs, and have all necessary services, supplies, and information. The 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 Will • Serve as point person to speak with patients, family members, and providers to address concerns pertaining to care, transfers and authorizations • 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, with end-to-end coordination, while adhering to all policies and procedures • Coordinate discharge needs from inpatient acute settings and skilled nursing facilities as appropriate for each member. • Coordinate timely delivery of last cover day letters to skilled nursing facilities • Discharge needs may include: durable medical equipment, home health services, specialist referrals, skilled nursing placement, transportation, and other needs Issue determinations within required regulatory timeframes • Apply evidenced-based criteria and guidelines, as well as clinical judgment and expertise, to help develop treatment plans • 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 • Review all acute/skilled nursing appeals and create detail explanation of non-coverage and reinstatement letters • Refer cases that do not meet established criteria to the Medical Directors for secondary review • Prepare, participate and facilitate high risk huddles and/or skilled nursing rounds Maintain a list of high risk patients and conduct regular outreach calls to check on their health status • Develop effective working relationships and collaboration with 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 and collaborating with external stakeholders, including contracted medical groups and vendors. • Other duties as assigned. • 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. Your Qualifications • Associate's Degree or equivalent experience • 3-5 years of related experience • CA LVN license • Performs work under direct supervision . • Handles basic issues and problems, and refers more complex issues to higher-level staff • Possesses beginning to working knowledge of subject matter. • Provides leadership, coaching, and/or mentoring to partner care coordinators. • Technical Expertise • Problem-Solving • Strong Communication • Customer/client focused • Detail oriented • Responsible What's in it for you? • Base salary range: $34.47 to $55.14 per hour • Work Mode: Remote • Annual bonus program • Robust Wellness Program • Generous paid-time-off (PTO) • Eleven paid holidays per year, plus 1 additional 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! We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!