Concurrent Review/Transition of Care Nurse, RN - Hybrid (Remote Considered) - 26-56

PriMed Management Consulting•San Ramon, CA

4d•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.
Two years of managed-care experience preferred.
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.

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.