Job Description

 

Registered Nurse 

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.

 Essential Functions

  • 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

Salary Range:

  • $92K-$215K

Position Type/Expected Hours of Work

  • Full Time - Monday thru Friday

We offer Full Time Employees:

  • Health Benefits
  • Dental
  • Vision
  • 401K
  • Generous Paid Time Off
  • Voluntary Employee Benefit Programs
  • Employee Referral Award Program

Location:

  • Staten Island

ABOUT US:

REV

Application Instructions

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