About SCAN
SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.
The Job
Manages the daily operations and continuous quality improvement of care management programs at SCAN to ensure the delivery of high quality, evidence based care with a focus on addressing the medical, behavioral health, and social needs of members. The goal is to oversee teams and programs that help achieve excellent health and support provider and member engagement.
You Will
Provides oversight of care management teams to drive operational excellence and productivity and to ensure the achievement of department goals and objectives.
Participates in establishing strategic plans and objectives; collecting and monitoring performance; developing dashboards and reports; and developing and evaluating programs and projects that promote health, improve member engagement, and address holistic member needs.
Ensures that department policies and procedures, desktop procedures, workflows, job aides, training materials, are current and accurately reflect processes in order to provide consistent quality care in compliance with department requirements.
Collaborates with internal department’s to ensure seamless care and support clinical and operational goals and create and review department metric reporting.
Builds effective professional relationships with providers and other internal and external partners utilizing verbal and written communication skills, developing trust, meeting timelines, respecting cultural differences, using active listening skills, and maintaining confidentiality.
Serves as a subject matter expert and represents the department at assigned committees to support two-way communication between department and committee and committee to department head and/or staff as appropriate.
Facilitates staff meetings and interdisciplinary team meetings.
Promotes process improvement, quality assurance, and compliance with and adheres to all regulatory and quality standards including but not limited to: Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and accreditation bodies’ standards such as the National Committee for Quality Assurance (NCQA) as it relates to Complex Care Management activities.
Consults with a SCAN Medical Director when needed and offers recommendations to the care team for medical and/or behavioral health management at the appropriate level of care.
Provides guidance and support with urgent and escalated issues. Acts as a resource to the Connecting Provider 2 Home team, MG care managers, physicians and other members of the health care team.
Maintains the member‘s right to privacy and protects SCAN operations by keeping information confidential.
Accomplishes results by communicating to staff job expectations; planning, monitoring, and appraising job results; coaching and counseling employees; initiating, coordinating, and enforcing systems, policies, and procedures.
Maintains staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities.
Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, participating in professional societies.
Contributes to the team effort by accomplishing related results as needed.
Actively supports the achievement of SCAN’s Vision and Goals.
Other duties as assigned
Your Qualifications
Bachelor’s degree. BSN or MSN preferred.
Current & Active Registered Nurse (RN) License.
Medicare/Medi-Cal experience in managed care environment.
2+ years of supervisory or management role required.
2+ of case management experience in a medical group, IPA and/or HMO setting preferred.
Bilingual Spanish strongly preferred. A test will be administered if applicable.
Strong written and oral communication skills, as well as strong interpersonal, critical thinking, and analytical skills.
Demonstrated ability to work with all levels of staff, within and external to the organization to achieve goals.
Experience with coordinating diverse groups of individuals to achieve success of the overall program.
Ability to prioritize multiple and competing tasks.
Ability to work independently or as a team while working in a fast-paced and dynamic environment.
Basic knowledge of related NCQA standards, CMS and DHCS regulations.
Medical and clinical terminology conversant.
What's in it for you?
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.
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