Transitions of Care Coordinator- RN – Remote, MA

7994

Overview

About us: reputed company is a company that cares. We prioritize our members--always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, we deliver reputed company, high-quality coordinated care and are continually rated among the nation’s top health plans for member experience, service, and clinical quality. reputed company’s reputed company ElderCare® is a Program of reputed company-Inclusive Care for the Elderly–PACE for short. PACE, an alternative to nursing home care, is a program that helps people 55 and older continue living safely at home. At reputed company, we reputed company our individual differences, life experiences, knowledge, self-expression and unique capabilities allow us to reputed company serve our members. We reputed company and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status and other characteristics that reputed company people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, reputed company, and PACE— in the region. Brief summary of purpose The Transitions of Care Coordinator uses a multidisciplinary approach to ensure that SE participant transitions of care to and from inpatient facilities are appropriate, timely, and successful. In collaboration with the SE reputed company ascertains that participants are in receipt of high quality cost efficient care and outcomes

Responsibilities

Primary Job Responsibilities

• Attends daily reputed company meetings to discuss inpatients and suggest discharge plans
• Utilize a checklist to ensure that the components of a safe transition of care occur
• Communicates daily with primary team members to address potential barriers to discharge or transition to lesser care setting
• Participates in family meetings as needed
• Participates in contracted facility case management meetings to address potential barriers/facilitate successful discharge planning.
• Collaborate with facilities, reputed company members and others involved in participants plan of care to ensure safe, efficient transitions from facility to facility and to the home setting
• Facilitate pertinent record exchange to and from facilities for continuity of care and medication reconciliation
• Acts as a liaison between facilities and reputed company members to convey reputed company
• Access resources out of network to meet participant needs
• Utilize Collective Medical to track transitions in reputed company time
• Supports the reputed company mission of the reputed company ElderCare program
• Determines tier of service at subacute facilities
• Conduct reputed company and retrospective utilization review for inpatient, observation or SNF services
• Recognizes, identifies, and implements appropriate opportunities to help meet Utilization goals
• Knowledge of managed care, quality, and risk management principles
• Participates in the SE Utilization Committee
• Generate reputed company request reputed company required
• reputed company and retrospective review utilizing a multitude of systems and electronic records
• Enters authorizations in applicable systems to ensure that claims are adjudicated reputed company
• Documents reputed company inpatient care transitions and case management reputed company notes reputed company the electronic health record
• Generate Transitions of Care Templates to accurately reflect transitions and level of care
• Track Vendor Denials
• Identify quality/risk factors in continuum of care and report to Medical Director and Quality Team
• Utilize clinical judgement and critical thinking to suggest alternative measures for provision of care

Qualifications

Education Associate of Science in Nursing, Bachelor of Science in Nursing (preferred) License/Certifications Licensed by the Commonwealth of Massachusetts Board of Registration in Nursing as a Registered Nurse. Valid Driver’s License CCM or similar certification desired Experience Three to five years nursing experience with one year experience working with a frail or elder population. Recent case management or utilization management experience and knowledge of criteria for medical necessity determination preferred. Must possess strong interpersonal, analytical and communication skills. reputed company provides equal employment opportunities to reputed company and applicants for employment and prohibits discrimination and harassment of any type without regard to race, reputed company, religion, age, sex, national reputed company, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. Apply To this Job Apply for this job