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The Care Transition Nurses is responsible for the initiative-taking, monitoring, swift action, and communication among team members within and outside the CCHP organization to provide oversight of CCHP’s delegated groups for the safe and effective transportation of inpatient care to CCHP’s preferred hospital providers. All clinically stable CCHP enrollees in a non-preferred facility, an out of network or out-of-area Emergency Department, Observation, a Medical-Surgical or Telemetry unit are triaged throughout the day for repatriation potential. The Care Transition Nurse works collaboratively every day with the staffs from Chinese Hospital, Astrana, Jade, Hill Physicians Medical Group and Royal Ambulance. The Care Transition Nurse evaluates every enrollee’s admitting diagnosis, risk factors, encounter history, and electronic medical record to understand the patient’s individual care needs and the clinical capabilities of all in and out of network hospitals and based on those factors and the patient’s stability for transfer determines when to initiate repatriation.
Essential Duties and Responsibilities
Where Chinese Hospital has the clinical capacity to care for the patient, Chinese Hospital is the preferred receiving hospital for repatriations; Chinese Hospital cannot accommodate the patient’s needs, Sutter CPMC Hospital is the second choice, other preferred hospital partners are used if Sutter CPMC cannot accept the enrollee. Provides oversight and leads all repatriation efforts on behalf of CCHP and Chinese Hospital Collaborates with medical group UM nurses, hospital staff, transfer centers. Identifies and documents potential barriers to successful care transitions and quickly develops solutions. Documents and maintains detailed patient reports and transition plans in the Repatriations Log. Advocates for the patient’s needs and preferences within the health care benefit structure Promptly escalates repatriation barriers to the CCHP CMO and Chinese Hospital Chief Nursing Officer. Assures cost effective and high quality of patient care by utilizing CCHP’s preferred in-network hospitals as clinically indicated. Assures appropriate utilization of inpatient resources that maximize adherence to evidence-based guidelines and high standards of quality care. Collaborates with the Care Coordination team. Collaborates with facility case managers and physicians to assure their participation and compliance with post discharge care. Collaborates with clinical social work services and pharmacy services in complex cases seeking assistance to improve the long-term care plans for the patient. Works with all department staff. Participates in UM audits as requested. Accepts and performs other duties as assigned. Qualifications
Bachelor’s degree or equivalent preferred Excellent verbal and written communication skills Bilingual in English and Chinese (Cantonese) Ability to set and change priorities quickly or as the situation warrants Able to work independently and as team player Proficiency in Word and Excel Ability to maintain high volume workload without compromising quality Minimum two years acute inpatient care experienced preferred At least one-year recent utilization management or case management experience preferred Physical Requirements
Able to lift up to 30 pounds Use proper body mechanics when handling equipment Standing, walking and moving 50% of the day. Compliance Requirements
Complies with CCHP Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs. Base Pay Scale
Starting at $40.63 – $60.89 per hour. The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.
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Where Chinese Hospital has the clinical capacity to care for the patient, Chinese Hospital is the preferred receiving hospital for repatriations; Chinese Hospital cannot accommodate the patient’s needs, Sutter CPMC Hospital is the second choice, other preferred hospital partners are used if Sutter CPMC cannot accept the enrollee. Provides oversight and leads all repatriation efforts on behalf of CCHP and Chinese Hospital Collaborates with medical group UM nurses, hospital staff, transfer centers. Identifies and documents potential barriers to successful care transitions and quickly develops solutions. Documents and maintains detailed patient reports and transition plans in the Repatriations Log. Advocates for the patient’s needs and preferences within the health care benefit structure Promptly escalates repatriation barriers to the CCHP CMO and Chinese Hospital Chief Nursing Officer. Assures cost effective and high quality of patient care by utilizing CCHP’s preferred in-network hospitals as clinically indicated. Assures appropriate utilization of inpatient resources that maximize adherence to evidence-based guidelines and high standards of quality care. Collaborates with the Care Coordination team. Collaborates with facility case managers and physicians to assure their participation and compliance with post discharge care. Collaborates with clinical social work services and pharmacy services in complex cases seeking assistance to improve the long-term care plans for the patient. Works with all department staff. Participates in UM audits as requested. Accepts and performs other duties as assigned. Qualifications
Bachelor’s degree or equivalent preferred Excellent verbal and written communication skills Bilingual in English and Chinese (Cantonese) Ability to set and change priorities quickly or as the situation warrants Able to work independently and as team player Proficiency in Word and Excel Ability to maintain high volume workload without compromising quality Minimum two years acute inpatient care experienced preferred At least one-year recent utilization management or case management experience preferred Physical Requirements
Able to lift up to 30 pounds Use proper body mechanics when handling equipment Standing, walking and moving 50% of the day. Compliance Requirements
Complies with CCHP Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs. Base Pay Scale
Starting at $40.63 – $60.89 per hour. The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.
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