Transitional Care Nurse

divh2Integrated Transition Care Nurse, RN/h2pLocation: This position is on a hybrid work schedule. (Monday Friday - remote, Tuesday - Thursday onsite in Rancho Cucamonga, CA)/ppUnder the direction of the Integrated Transition Care Department Leadership, the incumbent will work with Hospitals and Independent Physician Association (IPA) with their assigned Team Center, that may include an LCSW, CHW, Pharmacist, Pharmacy Technician, Coordinator, Care Transition, and Transportation to initiate coordinated and continuous cost-effective quality healthcare to ensure the continuity of the Members care needs are met timely throughout the continuum of care and readmission prevention for our high-risk Members. This will be accomplished through concurrent review processes using nationally recognized criteria. The Integrated Transitional Care Nurse, RN will participate in providing transitional care services to the Members with each transition from one care setting to the next./ppWhat You Will Do:/pulliConduct Integrated Transition Care discharge risk assessment for high risk/ high acuity Members./liliOversee and perform concurrent and retrospective reviews for medical necessity per evidenced based criteria, appropriateness of service and level of care, either through Telephonic review, clinical documentation submitted by respective facilities and/or electronic medical records (EMR) access./liliConduct reviews to ensure Members treatment plan is consistent with Diagnosis(es), specifically initial review within twenty-four (24) hours to ensure Members meet specified criteria for the respective admission(s)./liliWork in collaboration with the coordinator to ensure timely arrangements for transitions to higher or lower level of care and assist with transfer orders as needed./liliEnsure the concurrent or retrospective review process include referring cases that require clinical consultation with the medical director in a timely manner./liliEnsure cases are appropriately referred to Care Management, Behavioral health, Health Education, Housing, community health./liliIdentify outliers and prepare documentation as well as report on potential quality of care issues as identified./liliProcess timely completion of denials process per policy. The RN will review variances in cases followed by an LVN for possible consultation with the Medical Director to determine approval for due to medical necessity or denial of days./liliConduct timely compliance and completion of documents per regulatory requirements./liliServe as the Liaison between hospitals, IPAs vendors, outside agencies and provider to ensure effective communication and collaboration in an effort to meet the Members treatment plan and goals./liliOversee verification of delivery of ordered Durable Medical Equipment (DME), Health Home visits, set up hospital follow up visits with PCP, review of Medications with Member and transportation needs./liliOversee and complete Discharge planning assessment./liliPerform medication reconciliation based on acuity and type of medications./liliOutreach to Member post discharge to ensure Member attended follow up appointment, Health Home starts visits, possible in-home visit by RN or assigned LCSW as appropriate./liliGenerate additional follow up needed to assign to appropriate regional Behavioral Health Care Management team./li/ulpYou Will Be Successful If:/pulliKnowledge of evidence based clinical criteria and California Children Services (CCS)/liliMust have analytical skills/liliExcellent communication, interpersonal and organizational skills/liliSelf-starter and a team player/li/ulpWhat You Will Bring:/pulliTwo (2) or more years of Utilization Management/Case Management in a health care delivery setting in Acute or Skilled nursing, with an emphasis on Concurrent Review and Utilization Management/liliHigh school diploma or GED required ulliBachelors degree in Nursing from an accredited institution preferred/li/ul/liliPossession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required/liliMust have a valid California Drivers license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on insurance standards of no more than three (3) points/li/ulpAbout Impresiv Health:/ppImpresiv Health is a healthcare consulting partner specializing in clinical operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges./ppOur approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it./ppThats Impresiv!/p/div