Hybrid Rn I-Snp Care Transitions Coordinator

Summary

This position supports the I-SNP NP through a collaborative process for options and services to meet a 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

Discharge Planning

• In collaboration with all acute care facility discharge planners, performs initial review of all members for the early identification of discharge planning needs.
• Continually monitors patient's clinical status to assure the appropriate level of care based on established guidelines and amends the anticipated needs to support an optimal discharge plan.
• Intervenes with appropriate individuals/departments regarding delays in service that may have an impact on quality of patient care and/or length of stay and explores strategies to reduce length of stay and resource consumption with a focus on optimal patient outcomes and optimal reimbursement.
• Facilitates a comprehensive and collaboratives a transitional care plan based on care needs or members with the facility discharge planners and I-SNP NP
• Contributes to daily communication handoffs and maintains documentation of transitional care planning activities for members in CPHL EMR, (initial admission, daily or as appropriate based on condition, PRI, care plan updates etc.
• Records, updates and ensures accuracy of hospital logs, creates and updates Interruptions of Care

UM Activities

• In collaboration with the Utilization Management Department. facilitate prior authorization requests for scheduled medical appointments outside of NH
• Interprets federal and state regulations pertaining to coverage issues and provides education to team.
• Assist NPs with identification and confirmation of participating providers for community-based services requests
• Communicate network issues; i.e., problematic providers, network gaps, etc. to I-SNP management team and maintain documentation log

Skilled Level of Care (SLOC)

• Receive SLOC service request forms from NPs and evaluate request for completeness and appropriateness based on benefit criteria
• Maintain documentation of SLOC request for members in CPHL EMR
• Generate and distribute SLOC reports to individual nursing facilities
• Records, updates and ensures accuracy of SLOC logs

Audits

• Conducts monthly quality improvement audits and projects with the management team as directed

Care Plans

• Based on NP comprehensive HRA, creates a care plan for new members and all members annually in CPHL EMR within required timeframes.

Additional Responsibilities

• Facilitate voluntary disenrollment requests
• Actively participates in staff meetings, including case review, clinical documentation & coding, etc.
• Follows standard of care and clinical guidelines by keeping current with nursing literature and publications, professional organization, and Federal and State regulatory guidelines
• Ensures quality of care and customer satisfaction by providing necessary team support as needed when communicating team member issues that compromise care and satisfaction to the I-SNP management team
  

Competencies

• 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 standrad crieria (InterQual, Medicare LCP and NCP) in managed care and SNF/Long Term Care settings
• Knowledge of Federal and State regulations, managed care regulations and concepts, and CQI methodologies
• Ability to provide appropriate support and direction to facilitate collaborative efforts toward accomplishing established goals and objectives outlined in the I-SNP Model of Care.
• Excellent knowledge of computer software programs including case management software and / or EMR.
  

Supervisory Responsibility

This position has no supervisory responsibilities.

Work Environment

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, and photocopiers.

Physical Demands

This is largely a sedentary role.

Position Type and Expected Hours of Work

This is a full-time position. Days and hours of work are Monday through Friday, 9 a.m. to 5 p.m.   Some travel to hospitals and nursing facilities may be required

Required Education and Experience

• NYS RN license and registration.
• 3-5 years of clinical experience in a health care setting, preferably long term care
• Managed care and utlization management experience required.
• Working knowledge of utilization management, case management , subacute and long term care. 
• Knowledge of Medicare / Medicaid benefits and regulations required.
  

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.