SCAN

General

• Promote and support the quality, medical necessity, and cost effectiveness of care and services under state and federal regulations and Medical Policy
• Support utilization management processes related to coverage decisions and requests for items and services
• Conduct pre-service and concurrent reviews using established guidelines in collaboration with the Medical Director
• Apply case management principles to coordinate complex medical needs, care, and services
• Ensure inpatient, outpatient, and other services are delivered at the right time, level of care, and location
• Issue determinations within required regulatory timeframes
• Collect relevant information and apply evidence-based criteria, regulations, Medical Policy, DOFR, and member eligibility requirements
• Escalate requests to the Medical Director for secondary review when criteria are not met
• Manage complex cases through assessment, planning, implementation, coordination, advocacy, monitoring, and evaluation
• Prepare and deliver case presentations; participate in case rounds and interdisciplinary team meetings; incorporate recommendations into care plans
• Assist members requiring urgent or emergent out-of-network or out-of-area medical and behavioral health services
• Authorize stabilization services and transition members back to the SCAN network when appropriate
• Facilitate safe and effective inpatient discharges by communicating member needs to care team members
• Make referrals to clinical programs based on established criteria
• Address urgent member quality or access issues through the Quality of Care process
• Escalate workflow barriers to the supervisor or manager
• Maintain documentation and data-entry requirements
• Answer and return calls and correspondence according to telephone standards
• Build professional relationships with providers and internal and external partners while maintaining confidentiality
• Maintain professional and technical knowledge through education, publications, networking, and professional societies
• Support SCAN’s vision and goals
• Perform other duties as assigned

Medical Management Specialist, RN – Part-time

Program Manager

• Lead retention programs for assigned markets, translating member feedback, performance trends, and disenrollment insights into targeted actions
• Serve as the day-to-day retention partner to market leadership and cross-functional teams
• Lead quarterly listening sessions, including member targeting, invitations, RSVP management, reminders, participation tracking, follow-up, gift card distribution, and insight documentation
• Own post-listening session deliverables, including root cause analysis, process improvement recommendations, service recovery opportunities, and member follow-up coordination
• Provide disenrollment trends, rates, call data, listening session insights, and survey feedback to internal teams
• Partner with Sales Directors to maintain monitored agency and agent lists, investigate outlier performance, and provide monthly updates and recommended actions
• Track assigned markets against expected vDER goals, flag deviations, and support retention strategy, forecast, and market action plan adjustments
• Execute assigned market campaigns with the Retention Campaign Specialist and Data & Analytics; track participation and outcomes
• Maintain a shared log of listening sessions, campaigns, deliverables, owners, status, next steps, and progress
• Communicate timelines, barriers, risks, and escalations; cross-train and support additional markets as needed
• Support SCAN's Vision and Goals and perform other duties as assigned

Program Manager – Retention

Executive Assistant

• Deliver comprehensive administrative support to the CEO Office for Board events, logistics, and activities
• Manage complex calendars, schedule meetings, prioritize and respond to emails, and handle sensitive information
• Coordinate meeting schedules, travel arrangements, event management, and external commitments
• Maintain confidential department files and prepare the Board for engagements
• Plan and coordinate high-level meetings and events
• Arrange detailed travel itineraries, including flights, accommodation, transportation, and related activities
• Assist with strategic initiatives and special projects directed by the CEO and Chief of Staff
• Develop procedures to manage and track materials and documents for distribution
• Prepare agendas, meeting materials, records, evaluations, and follow-up reports
• Lead and facilitate a community of practice with other executive assistants
• Assist with administration of the executive office Board calendar and events
• Ensure consistent and cohesive brand representation internally and externally
• Support SCAN's vision and goals
• Perform other duties as assigned

Executive Assistant – Office of the CEO

Accountant

• Ensure timely and accurate monthly general ledger close, account analysis, financial analysis, account reconciliations, and schedule preparation for quarter-end, interim, and year-end financial, governmental, and tax audits
• Maintain accounting records and reconciliations with supporting documentation in accordance with company policies, procedures, and US GAAP
• Review, reconcile, and submit assigned accounts for manager review and sign-off
• Research and document reconciliation variances and record follow-up items within required timelines
• Review and validate departmental Expenditure Tracking Reports and prepare monthly expense accrual entries
• Prepare and record general ledger journal entries for bank activities, accruals, adjustments, reclasses, amortization, depreciation, intercompany billing and settlement, eliminations, allocations, and other activities
• Participate in monthly close meetings with FP&A, management, and finance team members
• Provide research and analytical support for financial fluctuation and trend analyses and explain variances to budget or prior periods
• Assist with interim and year-end audits and tax processes, including schedule preparation and supporting-document review
• File annual escheatment or Unclaimed Property and Business Personal Property
• Participate in special projects, ad hoc analysis, automation, and reporting-process improvement
• Assist with developing and reviewing policies and procedures and identifying control and process inefficiencies
• Cross-train with accounting department members and serve as mentor, resource, and backup
• Act as subject matter expert for general accounting and expense accruals
• Maintain professional and technical knowledge through education workshops, publications, networks, and professional societies
• Support SCAN’s Vision and Goals and perform other duties as assigned

Senior Accountant

Auditor

• Perform and provide oversight for the Managed Care Plan’s DHCS auditing team
• Conduct and oversee initial and subsequent reviews of Primary Care Provider sites, including Facility Site Reviews and Medical Record Reviews
• Complete monthly audit assignments within established timelines with thorough, compliant documentation
• Review, analyze, and interpret DHCS All Plan Letters, legislative, statutory, regulatory, and contract language
• Develop implementation and communication plans for regulatory compliance and provider data requirements
• Audit SCAN-contracted and collaborative PCP offices serving Medi-Medi members under CMS, DHCS, and contractual requirements
• Provide auditing and post-audit documentation training, feedback, and improvement recommendations
• Conduct closing meetings and provide preliminary overviews of compliance audit results
• Support providers with corrective action plans, CAP monitoring, education, and compliance tools
• Respond to provider disagreements with audit findings and analyze submitted reports and correction requests
• Explain regulation interpretations and their application
• Conduct annual oversight projects, correspondence, project coordination, delegated compliance monitoring, status reporting, and regulatory update coordination
• Represent the Delegation Oversight Unit as a service delivery compliance subject matter expert
• Partner with Compliance on SCAN policies related to NCQA, DHCS, CMS, and other regulatory revisions
• Escalate longstanding non-compliance issues and identify barriers for supervisors/managers
• Educate providers on delegated claims processing and denial of claims involving member liability
• Review delegated administrator letters, Compliance Program processes, and data submissions for accuracy and compliance
• Maintain member privacy and confidential information
• Adhere to quality, compliance, and regulatory standards
• Support SCAN’s vision and goals and perform other duties as assigned

Network Compliance Auditor, FSR – RN

Financial Planning and Analysis

• Oversee preparation of accurate financial statements in accordance with GAAP and regulatory standards
• Prepare monthly financial results, variance analysis, KPI reporting, and executive-level dashboards highlighting key trends and drivers
• Manage finance and accounting staff, delegate responsibilities, and ensure efficient workflow
• Develop annual budgets, quarterly forecasts, and multi-year financial models to support growth, profitability, and strategic initiatives
• Provide insights and analysis to support strategic decision-making and operational efficiency
• Ensure timely month-end and year-end close processes, audits, and tax filings
• Develop and enhance FP&A models, reporting tools, policies, and processes that improve the accuracy, efficiency, and scalability of finance operations
• Support reporting and compliance with CMS, DHCS, DMHC and other regulatory requirements
• Prioritize assignments, provide assistance, schedule work, and directly supervise others
• Actively support the achievement of SCAN’s Vision and Goals
• Perform other duties as assigned

Senior Finance Manager

Advocate

• Make outbound calls to members based on identified health interventions or quality initiatives
• Build rapport with members by communicating personal experience as a member and peer
• Provide health education and encourage positive behavior changes
• Coach members to create and implement strategies that minimize risks associated with common health conditions
• Encourage and assist members who encounter obstacles to seeking care
• Provide peer support, guidance, advocacy, resources, encouragement, and listening support for individuals facing mental health, addiction, or other life challenges

Junior Peer Advocate

• Coordinate the work of a team of Member Services Representatives providing customer service to members and associated individuals and groups
• Focus on intake for Part C and D Pre-Service Appeals
• Ensure member inquiries are addressed and members are referred to appropriate service providers
• Administer policies and procedures for verifying member identity, membership status, and entitlement to services
• Maintain current and accurate membership databases and records
• Suggest new service offerings or revisions to existing programs based on member feedback or gaps in coverage
• May participate in member retention or renewal efforts
• Support SCAN’s Vision and Goals
• Perform other duties as assigned

Grievances and Appeals Coordinator

Project Manager

• Support the planning, coordination, execution, and delivery of retention and renewal campaigns across markets.
• Prepare and maintain campaign plans, timelines, trackers, project documentation, outreach schedules, and status reports.
• Coordinate end-to-end campaign logistics, including member files, outreach readiness and training, tracking needs, workflow alignment, and follow-up activities.
• Partner with Retention Specialists, Data & Analytics, Product, Pharmacy, Member Services, Sales, and other cross-functional teams to support campaign execution, issue resolution, and follow-up needs.
• Maintain campaign trackers documenting member lists, outreach status, completion progress, participation, outcomes, risks, dependencies, and next steps.
• Review campaign requirements, identify interdependencies, coordinate work activities and schedules, and ensure assigned tasks are completed according to established timelines.
• Monitor campaign progress, identify and escalate barriers, delays, or risks, and support resolution within predefined guidelines and structured plans.
• Compile post-campaign results, including participation, outreach completion, retention outcomes, member feedback themes, lessons learned, and recommended improvements.
• Identify opportunities to improve future campaigns through trend review, process documentation, issue tracking, and post-campaign analysis.
• Support market-specific and national campaigns as assigned, ensuring consistent execution, communication, documentation, and reporting across workstreams.
• Actively support the achievement of SCAN’s Vision and Goals.
• Perform other duties as assigned.

Associate Project Manager – Retention Campaign Specialist

• Coordinate the work of a team of Member Services Representatives providing customer services to members and associated individuals and groups.
• Focus on Medicare Part C and D Grievances as a grievance “closer.”
• Ensure member inquiries are addressed and members are referred to appropriate service providers.
• Administer policies and procedures for verifying member identity, membership status, and entitlement to services.
• Maintain current and accurate membership databases and records.
• Suggest new service offerings or revisions to existing programs based on member feedback or gaps in coverage.
• May participate in member retention or renewal efforts.
• Support SCAN’s Vision and Goals.
• Perform other duties as assigned.

• Implement, analyze, and continuously improve an ERP system
• Focus on CTM and FCR work and tracking
• Assess functional requirements and initiate complex installations of ERP technologies meeting interdepartmental needs
• Ensure cross-functional access to systems
• Map business processes to ERP modules using ERP integration methodologies
• Administer user acceptance testing
• Communicate with programmers and other specialists regarding file design, testing, debugging, storage, access, and related activities
• Document, deliver, and administer training and related materials to end users
• Provide system support following implementation as needed
• Support SCAN’s Vision and Goals
• Perform other duties as assigned

Grievances and Appeals Triage Specialist

• Coordinate the work of a team of Member Services Representatives providing customer service to members and associated individuals and groups
• Ensure member inquiries are addressed and members are referred to appropriate service providers
• Administer policies and procedures for verifying member identity, membership status, and entitlement to services
• Maintain current and accurate membership databases and records
• Suggest new service offerings or revisions to existing programs based on member feedback or gaps in coverage
• May participate in member retention or renewal efforts
• Support SCAN’s Vision and Goals
• Perform other duties as assigned

• Coordinate the work of a team of Member Services Representatives providing customer service to members and associated individuals and groups
• Focus on Medicare Advantage Part C and D Post-Service Appeals
• Ensure member inquiries are addressed and refer members to appropriate service providers
• Administer policies and procedures for verifying member identity, membership status, and entitlement to services
• Maintain current and accurate membership databases and records
• Suggest new service offerings or revisions to existing programs based on member feedback or gaps in coverage
• May participate in member retention or renewal efforts
• Support SCAN’s Vision and Goals
• Perform other duties as assigned

• Coordinate the work of a team of Member Services Representatives providing customer services to members and associated individuals and groups.
• Focus on Medicare Part C and D Grievances as a grievance "closer."
• Ensure member inquiries are addressed and members are referred to appropriate service providers.
• Administer policies and procedures for verifying member identity, membership status, and entitlement to services.
• Maintain current and accurate membership databases and records.
• Suggest new service offerings or revisions to existing programs based on member feedback or gaps in coverage.
• May participate in member retention or renewal efforts.
• Support SCAN’s Vision and Goals.
• Perform other duties as assigned.

• Implement, analyze, and continuously improve an ERP system
• Focus on CTM and FCR work and tracking
• Assess functional requirements and initiate complex installations of ERP technologies meeting interdepartmental needs
• Ensure cross-functional access to systems
• Use ERP integration methodologies to map business processes to ERP modules, typically with assistance from consultants or vendors
• Administer user acceptance testing
• Communicate with programmers and specialists regarding file design, testing, debugging, storage, access, and related activities
• Document, deliver, and administer training and related materials to end users
• Provide system support following implementation when needed
• Support SCAN’s Vision and Goals
• Perform other duties as assigned