RN Transition Care Nurse

Profile

Description

At Conviva Care Solutions, we want to inspire people to live life their best healthy life. Conviva Care Solutions is a management services organization representing nearly 300 physician practices, 800 clinicians, and 300,000 patients across the states of Florida and Texas. We need people with a passion for helping others and making change happen. We don't want to be like everyone else in the industry-we want to be better. And we're looking for talent that wants to grow, be challenged and inspired to help make that happen.

Be a part of our Clinical Space - As a Transition Care Manager, you will provide guidance to facilitate care coordination and discharge planning services from inpatient facilities back to the patient's home. Must be an experienced nurse licensed as RN who is responsible for care facilitation, inpatient care management coordination, gathering clinical information to assure member is at right level of care at the right time. This nurse will follow and coordinate care while present in inpatient facilities and then throughout the subsequent care continuum until the member is able to return to prior level of functioning in the community. A high degree of collaboration with relationship building expertise is required as communication is required with many healthcare providers, particularly hospitalists and SNFists. The position will require onsite visits to assigned hospitals, skilled nursing facilities and home health agencies in local markets.

Responsibilities


Recommend services for utilizing care alternatives available within the community and nationally

Serve as clinical liaison with Humana, hospital, clinical and administrative staff as well as provide information and clinical expertise for clinical authorizations for inpatient care and outpatient services

Reconcile daily census to include discharges, admissions and denials

Stratify and/or validate patient level of risk and communicate during transition process with IDT

Collaborate effectively with the PCP interdisciplinary team (IDT) to establish an individualized plan of care to meet short and long term goals as members transition from acute inpatient to possible post- acute to home to clinic and back to community

Identify potentially unnecessary services and care delivery settings, and recommend alternatives if appropriate by analyzing clinical protocols

May visit patient/family in hospital, LTACH, IRF, SNF, long term care, assisted living or home settings for purpose of transition of patient

Review network participation, care with specialty networks, care with DME providers and transfers to alternative levels of care using your knowledge of benefit plan design

Educate providers regarding principles of medical management


Required Qualifications


Active RN license in the state in which the nurse practices

Minimum of 2 years prior clinical experience in an acute and/or post -acute setting

Proficient with computer skills particularly Excel, Word and PowerPoint

Possess ability to communicate well telephonically and face to face

Ability to travel to hospitals and SNF's within the Market

Previous Medicare Advantage/Medicare/Medicaid Experience a plus

Previous experience in SNF, LTAC, DME or Home Health


Preferred Qualifications


BSN
3-5 years of in home assessment and care coordination experience
Experience with health promotion, coaching and wellness
Previous managed care experience
Bilingual - English, Spanish


Additional Information/Role Competencies


Excellent written and verbal communication skills. Demonstrate active listening skills; communicate clearly and concisely; ensure understanding regardless of the communication vehicle; understand the needs and perspectives of others with ability to tailor the delivery accordingly.

Emotional Maturity as demonstrated by an understanding of oneself to manage emotions; listen to and understand others; able to build trusting relationships with patients, providers, and care team; understand proper use of chain of command and knows when and how to escalate.

Ability to work independently under general instruction but also understands how to collaborate with a team of all levels


Being a part of the Conviva team gives you: We offer tangible and intangible benefits such as medical, dental and vision benefits, 401k, tuition reimbursement, vacation, paid holidays, work-life balance, growth, a positive and fun culture and much more.


Attention to detail with ability to work in a fast paced environment to meet regulatory time frames

Responsible for achieving organization goals and metrics; accountable for results of assignment; takes accountability for results

Strong organization and time management skills with the ability to prioritize; organize and manage multiple priorities and/or projects using appropriate methodologies and tools

Demonstrated ability to create a positive and meaningful patient, provider and care team experience

Proactively identify, evaluate, and solve problems with logic and a systematic approach; look beyond the obvious to see root cause issues and creative solutions. Make appropriate decision in the face of ambiguity. Anticipate and resolves barriers and constraints

Flexible to changes in assignments and teams


Scheduled Weekly Hours

40

Company info

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