Transitional Care Nurse - RN required - Waipahu vacancy at WellCare Health Plans Inc. in Honolulu

WellCare Health Plans Inc. is presently looking of Transitional Care Nurse - RN required - Waipahu on Thu, 19 Jul 2012 10:58:00 GMT. Telephonically coordinates discharge planning for WellCare members to ensure a safe and effective transition from an inpatient setting to an appropriate lower level of care. Works closely with internal medical directors and concurrent review nurses to assess members' clinical and social needs, and to develop an individualized care plan that will provide a stable/supportive post-acute care...

Transitional Care Nurse - RN required - Waipahu

Location: Honolulu Hawaii

Description: WellCare Health Plans Inc. is presently looking of Transitional Care Nurse - RN required - Waipahu right now, this vacancy will be placed in Hawaii. More complete informations about this vacancy opportunity kindly see the descriptions. Telephonically coordinates discharge planning for WellCare members to ensure a safe and effective transition from an inpatient setting to an appropriate lower level of care. Works closely with internal medical directors and concurrent review nurses to assess members' clinical and social needs, and to develop an individualized care plan that will provide a stable/supportive post-acute care environment. Communicates effectively with members and their families, treating physicians, hospital staff, home care, DME, skilled nursing facilities and rehab providers to develop and implement the care plan, including the coordination and authorization of services, referrals to internal Wellcare programs such as case/disease management and behavioral health, and referrals to community based programs. May also provide short term case management (approximately 2 weeks or less) through member contacts after discharge to ensure that members' needs are met and services are available and accessed. DEPARTMENT: Health Services, State REPORTS TO: Sr. Manager, Field Utilization Management Essential Functions: Through internal communication with concurrent review nurses, medical directors and other internal departments, identifies members with high risk medical conditions that will require complicated medical treatments to establish an individualized post-acute plan of care to reduce the risk of complications and/or readmissions. Conducts patient interviews and assessments through telephonic contacts to determine appropriate level of interventions and assesses patient needs for follow up care. Initiates and continues direct communication with health care providers involved in the care of members, including treating physicians, IPA and/or hospitalists, to share information and collaboratively establish post-acute treatment plans for hospitalized members. Interacts with WellCare medical directors, concurrent review nurses and case/disease managers to evaluate the medical treatment plan and identify opportunities for optimizing clinical outcomes through referrals to specialty care programs or an alternate level of care. Documents clinical updates, authorizations and referrals in the WellCare medical management system adhering to Company documentation standards. Coordinates authorization and/or delivery of post-acute care services, including, but not limited to referrals to case and disease management, home health, medical equipment, skilled nursing facilities and other community based services. Provides members with educational resources to enhance their ability to access health care services, including WellCare contacts, primary care physician and other pertinent health care provider contacts. Facilitates referrals for post-discharge follow up with appropriate professional providers and support services (i.e. transportation) to ensure that members are able to access medically necessary services after discharge. Complies with all health plan and facility based regulations regarding HIPAA and patient safety and security. Identifies quality of care issues, and reports to appropriate WellCare Quality department representative. Performs special projects as assigned. Education: A Registered Licensed Nurse in the state of the physical working location. A Bachelor's Degree in Health Services or nursing preferred. Experience: Minimum of 3-5 general nursing experience with exposure to the following: E/R critical care, discharge planning, bedside care, and/or in an acute care facility. Managed care experience highly desired.. Ability to apply nursing judgement to make clinical decisions with minimal supervisory oversight. Payer experience and/or experience in InterQual preferred Licenses/Certifications: Registered Professional Nurse (RN) with current unrestricted license Special Skills (e.g. 2nd language): Demonstrated negotiation skills Demonstrated ability in problem solving and communications Previous experience working with treatment teams to meet the healthcare needs of participants Knowledge of community, state and federal laws and resources Ability to effectively present information and respond to questions from families, members, and providers Technical Skills/Requirements: Solid knowledge of email systems such a Microsoft Outlook Computer proficiency in Microsoft Word and Excel with some knowledge of Microsoft Access preferred. Knowledge of or the ability to learn company approved software such as CRMS, Peradigm, InterQual, Sidewinder and other software in order to perform job duties.
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This vacancy starts available on: Thu, 19 Jul 2012 10:58:00 GMT

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