Company Overview

Our Beginning

For more than 30 years SCAN Health Plan has been focusing on the unique needs of seniors. SCAN is a not-for-profit health plan dedicated to providing comprehensive medical coverage, prescription benefits and support services specifically designed to meet the needs of people on Medicare.

SCAN was founded in 1977 by a group of seniors who were frustrated by their lack of access to services and who wanted an organization that addressed their specific needs. These forward-thinking seniors formed the Senior Care Action Network, now known as SCAN Health Plan. The goal of the organization then was the same as it is today: to continue to find innovative ways to enhance seniors' ability to manage their health and to continue to control where and how they live. Since its inception, SCAN has provided the care needed to keep more than 25,000 seniors out of nursing homes. Today, SCAN is thriving and is one of the fastest growing health plans in the markets it serves.

Today

SCAN is based in Long Beach, California. The health plan has approximately 800 employees and serves close to 105,000 residents in Kern, Los Angeles, Orange, Riverside, San Bernardino San Diego and Ventura counties.

Also in Arizona, SCAN offers a health plan for Medicare and Medicaid-eligible individuals as part of the state's long term care program in Maricopa county.

SCAN also manages one of the largest and most successful Multi-Purpose Senior Service Projects (MSSP) in California. The MSSP provides community-based, long- term care and personal care coordination for low-income frail seniors. A similar program managed by SCAN, called Linkages, provides case management and community services to support independence for disabled adults.

The Future

SCAN is excited about expanding its mission to improve the lives of seniors through its benefit offerings and its overall expertise in senior health care. SCAN offers an innovative answer to the question of how to care for an increasing number of senior citizens. According to the U.S. Census, in 2001, 12.4% of the population was aged 65 and older. By 2030, however, people aged 65 and older are expected to make up 20% of the population. By expanding its membership and by maintaining its success, SCAN will meet its past, present and future goals: to provide the services necessary to help seniors maintain the best possible health while allowing them to remain independent.


 
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Manager, Utilization Management and Medi-Medi Integration , map it!US-CA-Long Beach

Job posted on: 11/8/2009

Job overview

Company:
 SCAN Health Plan
Location:
 map it!US-CA-Long Beach
Base Pay:
 N/A
Employee Type:
 Full-Time
Industry:
 Healthcare - Health Services
Manages Others:
 No
Job Type:
 Health Care
Req'd Education:
 2 Year Degree
Req'd Experience:
 Up to 5 year(s)
Req'd Travel:
 Not Specified
Relocation Covered:
 Not Specified
 
Contact:
 Not Available
Phone:
 Not Available
Email:
 Send Email Now
Fax:
 Not Available
Ref ID:
 UMM9809

Job Description

JOB PURPOSE:

To ensure that the Utilization Management department delivers efficient and quality service to members and providers, monitors and enhances utilization of services for members and promotes achievement of compliance with all regulatory and accrediting standards by supervising the activities of the Utilization Management staff.

  

ESSENTIAL JOB RESULTS:

Coordinates day to day department activities by providing strong leadership through recruiting, training, coaching, teaching, and supervising the Utilization Management clinical and non-clinical staff.  Establishes caseload assignments and measureable productivity metrics, develops meaningful management reports to reflect department activities and evaluation of programs to identify potential improvements.

 

Assures compliance with all regulatory standards issued by: Centers for Medicare and Medicaid (CMS), Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC) and accreditation standards such as the National Committee of Quality Assurance (NCQA).

 

Trains and assists staff in the interpretation of plan benefits by clarifying and verifying the organization's policies and procedures and staying abreast of coverage issues for the Medicare and Medi-Cal programs.  Maintains and updates the SCAN Medi-Cal Benefit Guidelines document.

 

Analyzes utilization by overseeing the collection and preparation of data and develops tracking and trending reports to evaluate staff productivity, contracted provider organizations and compliance monitoring.

 

Represents the Utilization Management department in appropriate Joint Operations Committee meeting with SCAN Provider Organizations; attends internal meetings and participates in SCAN committees and work groups as requested. Facilitates the Utilization Management Committee meetings.

 

Medi-cal and Medicare Integration – works to educate staff and oversee the following in regards to Medicare and Medi-Cal integration processes: Referrals, Service Denials, Member Appeals, Benefit Interpretation.

 

Contributes to the achievement of department goals and objectives by performing other duties as assigned.

 

Job Requirements

California R. N. required with a Bachelor’s Degree, Masters Degree is preferred

 

 5-7 years clinical experience with 3-4 years in positions of progressive authority and or management

 

Experience working for or with a managed care company, such as: medical groups, hospitals or HMO’s required

 

Certification in related filed desirable (CPUR, CCM, etc.)

 

Possess strong verbal, written and interpersonal communication skills

 

 

 
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