MCS Puerto Rico
Join MCS Puerto Rico as a Transitional Care Specialist.
GENERAL DESCRIPTION Responsible for identifying and managing discharged insureds in the Classicare business line and for coordinating the needs of discharged insureds from all business lines. Regular schedule; exempt status.
ESSENTIAL FUNCTIONS
Identifies discharged insureds who qualify for the transitional care program, performs a transitional care assessment to identify needs no later than the established period after discharge.
Establishes a care plan with specific goals based on the transitional care assessment results, including coordinating visits, reviewing medications, coordinating services, identifying contact person for the thirty days of active program, and resolving treatment limitations.
Conducts follow‑up interventions via telephone calls according to the patient’s level of risk, and closes the case within the established period.
Coordinates, with the corresponding Clinical Unit, the referrals necessary to implement services related to the patient’s needs.
Evaluates and determines if the requested discharge coordination services proceed according to the patient’s clinical needs and Medicare guidelines.
Discusses with the Medical Advisor cases that do not meet the medical need to offer services that the patient may need; determines the action plan to follow.
Complies with production, quality, and timing standards as per applicable regulations.
Meets the quality standards of the Special Needs Program (SNP).
Must comply fully and consistently with all company policies and procedures, local and federal laws, and applicable regulations to maintain appropriate business and employment practices.
May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this posting.
MINIMUM QUALIFICATIONS Education and Experience:
Bachelor's degree in Nursing Sciences with at least three (3) years of clinical experience and experience in documenting or analyzing medical records.
Certifications / Licenses:
Valid license and registration for Nursing Practice in Puerto Rico.
Languages:
Spanish – Intermediate (comprehensive, writing and verbal).
English – Intermediate (comprehensive, writing and verbal).
Other: N/A.
“Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento.”
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GENERAL DESCRIPTION Responsible for identifying and managing discharged insureds in the Classicare business line and for coordinating the needs of discharged insureds from all business lines. Regular schedule; exempt status.
ESSENTIAL FUNCTIONS
Identifies discharged insureds who qualify for the transitional care program, performs a transitional care assessment to identify needs no later than the established period after discharge.
Establishes a care plan with specific goals based on the transitional care assessment results, including coordinating visits, reviewing medications, coordinating services, identifying contact person for the thirty days of active program, and resolving treatment limitations.
Conducts follow‑up interventions via telephone calls according to the patient’s level of risk, and closes the case within the established period.
Coordinates, with the corresponding Clinical Unit, the referrals necessary to implement services related to the patient’s needs.
Evaluates and determines if the requested discharge coordination services proceed according to the patient’s clinical needs and Medicare guidelines.
Discusses with the Medical Advisor cases that do not meet the medical need to offer services that the patient may need; determines the action plan to follow.
Complies with production, quality, and timing standards as per applicable regulations.
Meets the quality standards of the Special Needs Program (SNP).
Must comply fully and consistently with all company policies and procedures, local and federal laws, and applicable regulations to maintain appropriate business and employment practices.
May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this posting.
MINIMUM QUALIFICATIONS Education and Experience:
Bachelor's degree in Nursing Sciences with at least three (3) years of clinical experience and experience in documenting or analyzing medical records.
Certifications / Licenses:
Valid license and registration for Nursing Practice in Puerto Rico.
Languages:
Spanish – Intermediate (comprehensive, writing and verbal).
English – Intermediate (comprehensive, writing and verbal).
Other: N/A.
“Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento.”
#J-18808-Ljbffr