Transition of Care Nurse

SAN JOAQUIN COUNTY HEALTH COMMISSION•French Camp, CA

16d•Remote

About The Position

Under general supervision, conducts transition of care coordination activities on assigned members where analysis, synthesis and evaluation of data and information are required. In addition, this position is responsible for developing, implementing, and evaluating individual transition care plans to ensure that care is rendered at the most appropriate level, for the requisite length of time, and in compliance with HPSJ, regulatory and contractual requirements. Work is varied and complex and requires a moderate amount of discretion and independent judgement.

Requirements

Strong clinical skills as defined in California scope of practice guidelines for RNs.
In-depth knowledge of and proficient skills in administering protocols for utilization management, discharge planning and/or case management.
In-depth knowledge of health care delivery systems as they apply to case management.
Ability to read, interpret and apply clinical information, practice guidelines and other complex data and information.
Strong skills in assessment and analysis.
Strong problem-solving skills.
Basic negotiation skills.
Produces work that is accurate and complete.
Produces the appropriate amount of work.
Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
Rebounds from setbacks and adversity when facing difficult situations.
Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
Interpersonal skills - interact effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
Strong oral and written communication skills, with the ability to communicate professionally to diverse individuals inside and outside of HPSJ, effectively explain complex information, and document according to standards.
Ability to use tact and diplomacy to diffuse emotional situations.
Ability to work independently and as part of a team.
Time management and organizational skills. Use time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
Strong customer service skills.
Basic skills in Word and Excel.
Ability to enter data into and navigate through multiple databases.
Ability to speak and be understood in English.
May require proficiency in one of HPSJ’s threshold languages (as defined by HPSJ’s Cultural and Linguistic Program).
Ability to handle confidential information with appropriate discretion.
Knowledge of government sponsored programs and regulations as they apply to case management.
Knowledge of managed care principles, practices, and regulatory requirements as they apply to case management.
Graduation from an accredited nursing school.
At least three years clinical experience as an RN in a hospital or clinic.
At least three years performing case management, utilization management or discharge planning.
Unrestricted California Registered Nurse license.
Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability.

Nice To Haves

Experience as a clinician in a managed care setting.
Experience working with Medi-Cal and/or Medicare populations.
Certified Case Manager Designation.

Responsibilities

Assesses and evaluates members’ care needs.
Educates members on HPSJ services and the case management process.
Collaborate with members, his/her family, and external and internal resources to ensure understanding of and compliance with care plans.
Identifies care issues and collaborates with provider to resolve; escalates as necessary.
Escalates high risk medical issues to Medical Director for review; approves or denies services as directed.
Monitors and evaluates progress at appropriate intervals; conducts appropriate interventions.
Supports and advises members on self-advocacy efforts.
Documents activities in appropriate HPSJ system(s) according to standards.
Other duties as required.

Benefits

Competitive salary
Robust and affordable health/dental/vision with choices in providers
Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
Two flexible spending accounts (FSAs)
Employer-Paid Term Life and AD&D Insurance
Employer-Paid Disability Insurance
Employer-Paid Life Assistance Program
Health Advocacy
Supplemental medical, legal, identity theft protection
Access to exclusive discount mall
Education and training reimbursement in addition to employer-paid elective learning courses.
A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
A shorter commute – if you’re commuting from the Central Valley to the Bay Area.
Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.