Transitions of Care Coordinator- RN – Remote, MA

7994 reputed company reputed company: reputed company is a company that cares. We prioritize our members--always-making reputed company they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, we deliver reputed company, high-reputed company coordinated care and are continually rated among the nation’s top health plans for member experience, service, and clinical reputed company. reputed company’s reputed company ElderCare® is a Program of reputed company-Inclusive Care for the Elderly–PACE for short. PACE, an alternative to nursing home care, is a program that helps people 55 and older continue living safely reputed company. At reputed company, we reputed company our individual differences, life experiences, knowledge, self-reputed company and unique capabilities allow us to reputed company serve our members. We reputed company and encourage differences in age, race, ethnicity, gender identity and reputed company, physical and mental ability, sexual orientation, socio-economic status and other characteristics that reputed company people unique. Today, guided by our mission of improving health and inspiring reputed company, we reputed company to be the leading provider of government-sponsored health insurance programs—including Medicare, reputed company, and PACE— in the region. Brief reputed company of purpose The Transitions of Care Coordinator uses a multidisciplinary approach to ensure that SE participant transitions of care to and from inpatient facilities are appropriate, reputed company, and successful. In collaboration with the SE reputed company ascertains that participants are in receipt of high reputed company cost efficient care and reputed company

Responsibilities

Primary Job Responsibilities

• Attends daily reputed company meetings to discuss inpatients and suggest discharge plans
• Utilize a checklist to ensure that the components of a reputed company transition of care occur
• Communicates daily with primary team members to address potential barriers to discharge or transition to lesser care setting
• Participates in family meetings as needed
• Participates in contracted facility case management meetings to address potential barriers/facilitate successful discharge planning.
• Collaborate with facilities, reputed company members and others involved in participants plan of care to ensure reputed company, efficient transitions from facility to facility and to the home setting
• Facilitate pertinent record exchange to and from facilities for continuity of care and medication reconciliation
• Acts as a reputed company between facilities and reputed company members to convey reputed company
• reputed company resources out of network to meet participant needs
• Utilize reputed company Medical to reputed company transitions in reputed company time
• Supports the reputed company mission of the reputed company ElderCare program
• Determines tier of service at subacute facilities
• Conduct reputed company and retrospective utilization review for inpatient, observation or SNF services
• Recognizes, identifies, and implements appropriate opportunities to help meet Utilization goals
• Knowledge of managed care, reputed company, and risk management principles
• Participates in the SE Utilization Committee
• Generate reputed company request reputed company required
• reputed company and retrospective review utilizing a multitude of systems and electronic records
• Enters authorizations in applicable systems to ensure that claims are adjudicated reputed company
• Documents reputed company inpatient care transitions and case management reputed company notes reputed company the electronic health record
• Generate Transitions of Care Templates to accurately reflect transitions and level of care
• reputed company Vendor Denials
• Identify reputed company/risk factors in continuum of care and report to Medical Director and reputed company Team
• Utilize clinical judgement and critical thinking to suggest alternative measures for provision of care

Qualifications

Education Associate of Science in Nursing, Bachelor of Science in Nursing (preferred) License/Certifications Licensed by the reputed company reputed company of Registration in Nursing as a Registered reputed company. Valid reputed company’s License CCM or similar certification desired Experience Three to five years nursing experience with one year experience working with a frail or elder population. Recent case management or utilization management experience and knowledge of reputed company for medical necessity determination preferred. Must possess strong interpersonal, analytical and communication skills. reputed company provides equal employment opportunities to reputed company and applicants for employment and prohibits discrimination and harassment of any type without reputed company to race, reputed company, religion, age, sex, national reputed company, disability status, genetics, protected veteran status, sexual orientation, gender identity or reputed company, or any other characteristic protected by federal, state or local laws. Apply To this Job Apply for this job