Concurrent Review/Transition of Care Nurse, RN

PriMed Management Consulting • Sherman Oaks, CA

1d • Hybrid

About The Position

Responsible for proactively assisting in the transition of care process by demonstrating collaborative action to facilitate smooth transitions through varying levels of care and throughout the care continuum. Monitor inpatient utilization, assist with facilitation of the discharge or transfer plans and provide discharge follow up to assure that medical care is appropriate and efficient.

Requirements

• Minimum three years clinical nursing experience in an area such as medical surgical, critical care, home health or skilled nursing.
• Possess optimum organizational skills with the ability to meet both expected and unexpected time frames.
• Proficient in MS office applications and other computer skills.
• Ability to coordinate effectively with a variety of customers including members, providers, office staff, health plans, internal department, community resources, and peers.
• Active, unrestricted California Registered Nursing License.

Nice To Haves

• two years of managed-care experience preferred.

Responsibilities

• Support the interdisciplinary team approach to ensure effective resource utilization, as well as quality and cost-effective outcomes.
• Follow designated TOC workflows to assure consistency and accountability.
• Monitor inpatient utilization according to identified criteria.
• Facilitate discharge planning.
• Proactively and collaboratively interface with physicians, hospital staff, members and their families to assist in expediting appropriate discharge.
• Serve as a liaison between the hospital, health plan, vendors, and providers.
• Coordinate internal and external resources for the individual member.
• May provide telephonic post hospital follow-up to assure members understanding of the discharge instructions and current treatment plan.
• Determine what home services were ordered at the time of discharge and assure that services ordered have been received or activated.
• Provide medication reconciliation and refer to pharmacist as warranted.
• Assure member is established with appropriate providers and is receiving appropriate and timely follow up.
• Assess for any issues that may require ongoing case management.
• Assure member has adequate support.
• Support a positive work environment and foster teamwork.
• Maintain client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.
• Maintain department procedure/policy standards with regard to turnaround time, etc.
• Abide by and maintain telecommuting standards.
• Adhere to the policy and procedures of assigned hospital(s).
• Meet Care Coordination attendance and availability standards.
• Build and maintain appropriate relationships on behalf of HPMG.

Benefits

• Hill Physicians has much to offer prospective employees.
• We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.”
• When you join our team, you’re making a great choice for your professional career and your personal satisfaction.
• At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced.
• Whatever your relationship with Hill Physicians, we welcome ALL that you are.
• We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes.
• Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities.
• We do it because it's right!

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 251-500 employees