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 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.

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.