Role Title: Transition Care RN
Location: Palm Beach County
Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Conviva Care Solutions we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Conviva Care Solutions, we’re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.
Be a part of our Clinical Space – As a Transition Care RN, you will facilitate care coordination and discharge planning services telephonically with hospitals, skilled nursing facilities and home that assures the right level of care at the time of facility discharge. Must be an experienced nurse licensed as RN who is responsible for utilization management, inpatient care management coordination, gathering clinical information to assure member is at right level of care at the right time. This nurse will follow and coordinate care telephonically while the patient is at the hospital and then throughout the subsequent care continuum until the member is able to return to prior level of functioning in the community.
• Recommend services for utilizing care alternatives available within the community and nationally
• Serve as clinical liaison with Humana, hospital, clinical and administrative staff as well as provide information and clinical expertise for clinical authorizations for inpatient care and outpatient services
• Reconcile daily census to include discharges, admissions and denials
• Stratify and/or validate patient level of risk and communicate during transition process with IDT
• Collaborate effectively with the PCP interdisciplinary team (IDT) to establish an individualized plan of care to meet short and long term goals as members transition from acute inpatient to possible post- acute to home to clinic and back to community
• Identify potentially unnecessary services and care delivery settings, and recommend alternatives if appropriate by analyzing clinical protocols
• May visit patient/family in hospital, LTACH, IRF, SNF, long term care, assisted living or home settings for purpose of transition of patient
• Review network participation, care with specialty networks, care with DME providers and transfers to alternative levels of care using your knowledge of benefit plan design
• Monitor utilization management activities, analyze reports for clinical indicators requiring intervention, and report trends
• Educate providers regarding principles of medical management
• Telephonically assess and evaluate members’ needs and requirements to achieve and/or maintain their health
• Excellent written and verbal communication skills. Demonstrate active listening skills; communicate clearly and concisely; ensure understanding regardless of the communication vehicle; understand the needs and perspectives of others with ability to tailor the delivery accordingly.
• Emotional Maturity as demonstrated by an understanding of oneself to manage emotions; listen to and understand others; able to build trusting relationships with patients, providers, and care team; understand proper use of chain of command and knows when and how to escalate.
• Ability to work independently under general instruction but also understands how to collaborate with a team of all levels
• Attention to detail with ability to work in a fast paced environment to meet regulatory time frames
• Responsible for achieving organization goals and metrics; accountable for results of assignment; takes accountability for results
• Strong organization and time management skills with the ability to prioritize; organize and manage multiple priorities and/or projects using appropriate methodologies and tools
• Demonstrated ability to create a positive and meaningful patient, provider and care team experience
• Proactively identify, evaluate, and solve problems with logic and a systematic approach; look beyond the obvious to see root cause issues and creative solutions. Make appropriate decision in the face of ambiguity. Anticipate and resolves barriers and constraints
• Flexible to changes in assignments and teams
• Active RN license in the state in which the nurse practices
• Minimum of 2 years prior clinical experience in an acute and/or post -acute setting
• Proficient with computer skills particularly Excel, Word and PowerPoint
• Possess ability to communicate well telephonically
• Ability to travel for Orientation 1 week to 3 months as needed
• Travel to required meetings up to 6 times a year as requested
• Previous Medicare Advantage/Medicare/Medicaid Experience a plus
• Previous experience in Front End Review, SNF, LTAC, DME or Home Health
Long Term Care