Alura Workforce Solutions
Integrated Transitional Care Nurse, RN 24-00341
Alura Workforce Solutions - Rancho Cucamonga, California, United States, 91739
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Overview
Integrated Transitional Care Nurse, RN 24-00341
Integrated Transitional Care Nurse, RN 24-00341
1 day ago Be among the first 25 applicants Description
Join our dynamic team in the Integrated Transition Care Department! Under visionary leadership, you'll collaborate with hospitals and Independent Physician Associations to deliver continuous, quality healthcare to our high-risk Members. As the Integrated Transitional Nurse, RN, you'll lead risk assessments, oversee reviews, and ensure seamless transitions between care settings. Dive into collaboration with various departments, identifying outliers, and ensuring compliance. Be the liaison between stakeholders, contributing to effective communication and goal achievement. Join us and be a part of revolutionizing transitional healthcare! Conduct Integrated Transition Care discharge risk assessment for high risk/ high acuity Members. Oversee and perform concurrent and retrospective reviews for medical necessity per evidenced based criteria, appropriateness of service and level of care, either through Telephonic review, clinical documentation submitted by respective facilities and/or electronic medical records (EMR) access. Conduct reviews to ensure Member's treatment plan is consistent with Diagnosis(es), specifically initial review within twenty-four (24) hours to ensure Members meet specified criteria for the respective admission(s). Work in collaboration with the coordinator to ensure timely arrangements for transitions to higher or lower level of care and assist with transfer orders as needed. Ensure the concurrent or retrospective review process include referring cases that require clinical consultation with the medical director in a timely manner. Ensure cases are appropriately referred to Care Management, Behavioral health, Health Education, Housing, community health. Identify outliers and prepare documentation as well as report on potential quality of care issues as identified. Process timely completion of denials process per policy. The RN will review variances in cases followed by an LVN for possible consultation with the Medical Director to determine approval for due to medical necessity or denial of days. Conduct timely compliance and completion of documents per regulatory requirements. Serve as the company Liaison between hospitals, IPAs vendors, outside agencies and provider to ensure effective communication and collaboration to meet the Member's treatment plan and goals. Oversee verification of delivery of ordered Durable Medical Equipment (DME), Health Home visits, set up hospital follow up visits with PCP, review of Medications with Member and transportation needs. Oversee and complete Discharge planning assessment. Perform medication reconciliation based on acuity and type of medications. Outreach to Member post discharge to ensure Member attended follow up appointment, Health Home starts visits, possible in-home visit by RN or assigned LCSW as appropriate. Generate additional follow up needed to assign to appropriate regional Behavioral Health & Care Management team.
Title
Integrated Transitional Care Nurse, RN
(Managed Care Health Plan)
Position Type:
Remote
Schedule : M-F, 8:00 am – 5:00 pm
Description
Join our dynamic team in the Integrated Transition Care Department! Under visionary leadership, you'll collaborate with hospitals and Independent Physician Associations to deliver continuous, quality healthcare to our high-risk Members. As the Integrated Transitional Nurse, RN, you'll lead risk assessments, oversee reviews, and ensure seamless transitions between care settings. Dive into collaboration with various departments, identifying outliers, and ensuring compliance. Be the liaison between stakeholders, contributing to effective communication and goal achievement. Join us and be a part of revolutionizing transitional healthcare!
Conduct Integrated Transition Care discharge risk assessment for high risk/ high acuity Members. Oversee and perform concurrent and retrospective reviews for medical necessity per evidenced based criteria, appropriateness of service and level of care, either through Telephonic review, clinical documentation submitted by respective facilities and/or electronic medical records (EMR) access. Conduct reviews to ensure Member's treatment plan is consistent with Diagnosis(es), specifically initial review within twenty-four (24) hours to ensure Members meet specified criteria for the respective admission(s). Work in collaboration with the coordinator to ensure timely arrangements for transitions to higher or lower level of care and assist with transfer orders as needed. Ensure the concurrent or retrospective review process include referring cases that require clinical consultation with the medical director in a timely manner. Ensure cases are appropriately referred to Care Management, Behavioral health, Health Education, Housing, community health. Identify outliers and prepare documentation as well as report on potential quality of care issues as identified. Process timely completion of denials process per policy. The RN will review variances in cases followed by an LVN for possible consultation with the Medical Director to determine approval for due to medical necessity or denial of days. Conduct timely compliance and completion of documents per regulatory requirements. Serve as the company Liaison between hospitals, IPAs vendors, outside agencies and provider to ensure effective communication and collaboration to meet the Member's treatment plan and goals. Oversee verification of delivery of ordered Durable Medical Equipment (DME), Health Home visits, set up hospital follow up visits with PCP, review of Medications with Member and transportation needs. Oversee and complete Discharge planning assessment. Perform medication reconciliation based on acuity and type of medications. Outreach to Member post discharge to ensure Member attended follow up appointment, Health Home starts visits, possible in-home visit by RN or assigned LCSW as appropriate. Generate additional follow up needed to assign to appropriate regional Behavioral Health & Care Management team.
Requirements
Two (2) or more years of Utilization Management / Case Management in a health care delivery setting in Acute or Skilled nursing, with an emphasis on Concurrent Review and Utilization Management Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required Yes, must have a valid California Driver's license and valid automobile insurance Must qualify and maintain driving record to drive company vehicles based on company insurance standards of no more than three (3) points Knowledge of evidence based clinical criteria and California Children Services (CCS) Must have analytical skills. Excellent communication, interpersonal and organizational skills
INDH Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at Alura Workforce Solutions by 2x Sign in to set job alerts for “Progressive Care Nurse” roles.
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Integrated Transitional Care Nurse, RN 24-00341
1 day ago Be among the first 25 applicants Description
Join our dynamic team in the Integrated Transition Care Department! Under visionary leadership, you'll collaborate with hospitals and Independent Physician Associations to deliver continuous, quality healthcare to our high-risk Members. As the Integrated Transitional Nurse, RN, you'll lead risk assessments, oversee reviews, and ensure seamless transitions between care settings. Dive into collaboration with various departments, identifying outliers, and ensuring compliance. Be the liaison between stakeholders, contributing to effective communication and goal achievement. Join us and be a part of revolutionizing transitional healthcare! Conduct Integrated Transition Care discharge risk assessment for high risk/ high acuity Members. Oversee and perform concurrent and retrospective reviews for medical necessity per evidenced based criteria, appropriateness of service and level of care, either through Telephonic review, clinical documentation submitted by respective facilities and/or electronic medical records (EMR) access. Conduct reviews to ensure Member's treatment plan is consistent with Diagnosis(es), specifically initial review within twenty-four (24) hours to ensure Members meet specified criteria for the respective admission(s). Work in collaboration with the coordinator to ensure timely arrangements for transitions to higher or lower level of care and assist with transfer orders as needed. Ensure the concurrent or retrospective review process include referring cases that require clinical consultation with the medical director in a timely manner. Ensure cases are appropriately referred to Care Management, Behavioral health, Health Education, Housing, community health. Identify outliers and prepare documentation as well as report on potential quality of care issues as identified. Process timely completion of denials process per policy. The RN will review variances in cases followed by an LVN for possible consultation with the Medical Director to determine approval for due to medical necessity or denial of days. Conduct timely compliance and completion of documents per regulatory requirements. Serve as the company Liaison between hospitals, IPAs vendors, outside agencies and provider to ensure effective communication and collaboration to meet the Member's treatment plan and goals. Oversee verification of delivery of ordered Durable Medical Equipment (DME), Health Home visits, set up hospital follow up visits with PCP, review of Medications with Member and transportation needs. Oversee and complete Discharge planning assessment. Perform medication reconciliation based on acuity and type of medications. Outreach to Member post discharge to ensure Member attended follow up appointment, Health Home starts visits, possible in-home visit by RN or assigned LCSW as appropriate. Generate additional follow up needed to assign to appropriate regional Behavioral Health & Care Management team.
Title
Integrated Transitional Care Nurse, RN
(Managed Care Health Plan)
Position Type:
Remote
Schedule : M-F, 8:00 am – 5:00 pm
Description
Join our dynamic team in the Integrated Transition Care Department! Under visionary leadership, you'll collaborate with hospitals and Independent Physician Associations to deliver continuous, quality healthcare to our high-risk Members. As the Integrated Transitional Nurse, RN, you'll lead risk assessments, oversee reviews, and ensure seamless transitions between care settings. Dive into collaboration with various departments, identifying outliers, and ensuring compliance. Be the liaison between stakeholders, contributing to effective communication and goal achievement. Join us and be a part of revolutionizing transitional healthcare!
Conduct Integrated Transition Care discharge risk assessment for high risk/ high acuity Members. Oversee and perform concurrent and retrospective reviews for medical necessity per evidenced based criteria, appropriateness of service and level of care, either through Telephonic review, clinical documentation submitted by respective facilities and/or electronic medical records (EMR) access. Conduct reviews to ensure Member's treatment plan is consistent with Diagnosis(es), specifically initial review within twenty-four (24) hours to ensure Members meet specified criteria for the respective admission(s). Work in collaboration with the coordinator to ensure timely arrangements for transitions to higher or lower level of care and assist with transfer orders as needed. Ensure the concurrent or retrospective review process include referring cases that require clinical consultation with the medical director in a timely manner. Ensure cases are appropriately referred to Care Management, Behavioral health, Health Education, Housing, community health. Identify outliers and prepare documentation as well as report on potential quality of care issues as identified. Process timely completion of denials process per policy. The RN will review variances in cases followed by an LVN for possible consultation with the Medical Director to determine approval for due to medical necessity or denial of days. Conduct timely compliance and completion of documents per regulatory requirements. Serve as the company Liaison between hospitals, IPAs vendors, outside agencies and provider to ensure effective communication and collaboration to meet the Member's treatment plan and goals. Oversee verification of delivery of ordered Durable Medical Equipment (DME), Health Home visits, set up hospital follow up visits with PCP, review of Medications with Member and transportation needs. Oversee and complete Discharge planning assessment. Perform medication reconciliation based on acuity and type of medications. Outreach to Member post discharge to ensure Member attended follow up appointment, Health Home starts visits, possible in-home visit by RN or assigned LCSW as appropriate. Generate additional follow up needed to assign to appropriate regional Behavioral Health & Care Management team.
Requirements
Two (2) or more years of Utilization Management / Case Management in a health care delivery setting in Acute or Skilled nursing, with an emphasis on Concurrent Review and Utilization Management Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required Yes, must have a valid California Driver's license and valid automobile insurance Must qualify and maintain driving record to drive company vehicles based on company insurance standards of no more than three (3) points Knowledge of evidence based clinical criteria and California Children Services (CCS) Must have analytical skills. Excellent communication, interpersonal and organizational skills
INDH Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at Alura Workforce Solutions by 2x Sign in to set job alerts for “Progressive Care Nurse” roles.
RN Registered Nurse - ICU - Full Time Night
West Covina, CA $45.26-$56.27 5 months ago Nurse Manager - Cath Lab and Special Procedures
Sp Unit Staff RN - Hospital - SDU - Full Time Nights
Corona, CA $75,380.00-$160,850.00 3 months ago Integrated Transitional Care Nurse, RN 24-00367
Pomona, CA $2,240.82-$2,240.82 6 months ago Baldwin Park, CA $45.26-$56.27 4 months ago Temporary Seasonal Staff RN Hospital - Med/Surg/Tele
Registered Nurse RN ICU - full time nights
Corona, CA $88,358.00-$132,357.00 1 week ago Temporary Seasonal Staff RN Hospital - Med/Surg/Tele
Temporary Seasonal Staff RN Hospital - Med/Surg/Tele
Temporary Seasonal Sp Unit Staff RN Hospital - DOU/SDU PT Days
Pomona, CA $77,580.00-$161,880.00 9 months ago Pomona, CA $77,580.00-$161,880.00 6 months ago Temporary Seasonal Staff RN Hospital - Med/Surg/Tele PT Days
Temporary Seasonal Sp Unit Staff RN - DOU/SDU
Temporary Seasonal Sp Unit Staff RN - DOU/SDU
Corona, CA $75,380.00-$160,850.00 2 months ago Specialty Unit Staff RN - Hospital - SDU - Full Time Nights
March Air Reserve Base, CA $28.00-$30.00 2 weeks ago Temporary Seasonal Sp Unit Staff RN - DOU/SDU
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr