Registered Nurse (RN)
This position supports the I-SNP program through a collaborative process for options and services to meet member’s health needs. Allows for appropriate allocation of member benefits and resources through a collaborative partnership with participating nursing facilities and providers.
- Facilitate authorizations and scheduling of medical appointments outside of NH.
- Ensure that the member has a seamless transition from one level of care to another based on regulatory requirements, Department policy & procedures and established best practice.
- Communicate daily with hospital staff regarding admissions and discharge of I-SNP members and ascertain their plans for a timely discharge.
- Educate hospital staff of I-SNP Model of Care and clinical skill level of nursing facility to promote early discharge to nursing facility.
- Assist as needed with effectuating discharge plan including identification of participating network providers and providing authorizations as required.
- Meet with hospital staff as needed
- Document discharge plan as an ongoing review.
- Participants in and present cases at weekly team case review meetings.
- Document recommendations discussed in case review meetings within one business day and coordinate as needed.
- Monitor to ensure proper utilization of all benefits including skilled care services and level of care changes
- Work with I-SNP management team on facility report generation and distribution
- Monitor adherence to care plans, evaluate effectiveness, monitor patient progress in a timely manner, and facilitate changes as needed
- Collaborate and assist NPs in identifying level of care changes
- Ensure participating facilities are educated and comply with CPHL policies and procedures that ensure effective coordination of care as outlined in the model of care
- Records, updates and ensures accuracy of hospital and SNK logs
- Assist management team with monthly monitoring and audit activities.
- Develops and facilitates collaborative partnerships with all members of the care team
- Work closely with management team on development and implementation of methods, policies and procedures to improve the Departments’ efficiency and overall effectiveness.
- Identifies and reports utilization trends and patterns monthly, quarterly and annually.
Knowledge, Skill Set & Qualifications Required
Excellent customer service, oral communication, writing, and presentation skills.
- Ability to demonstrate effective critical thinking and problem solving skills.
- Excellent interpersonal skills.
- 2-3 years experience; discharge planning, managed care government programs, UM, application of standard criteria (InterQual, Medicare LCP and NCP) in managed care and SNF/Long Term Care settings
- Excellent knowledge of computer software programs including case management software and / or EMR
Position Type/Expected Hours of Work
- Full Time - Monday thru Friday
We offer Full Time Employees:
- Health Benefits
- Generous Paid Time Off
- Voluntary Employee Benefit Programs
- Employee Referral Award Program
- Staten Island