Care Neighborhood RN
San Leandro, California | Direct Hire
Working with other interdisciplinary staff in the Care Neighborhood program (MD, MSWs, LCSWs, and CHWs) the Care Neighborhood RN will empower identified high risk-high needs patients to improve their health outcomes and will follow their care in a variety of settings – home, clinic, hospital and skilled nursing. Each patient in Care Neighborhood had an identified professional working with them (MSW, CHW). The Care Neighborhood RN will consult with the patient-CN dyad: activities can include visiting members, disease education, medication reconciliation and support to patients and families around continuing medical needs. When the patient is hospitalized, activities may include discharge planning, referrals, DME arrangements etc.
- RN, Active, unrestricted, California Nursing License (Registered Nurse)
- Minimum 3 years of Medical clinical nursing experience
- Minimum 1 year of UM/CM experience in hospital, HMO, or IPA setting.
- Excellent communication, organizational and time management skills with the ability to meet tight timeframes.
- Strong understanding of the managed care environment.
- Ability to work effectively and collaboratively with a variety of customers including hospital/office staff, health plans, members and physicians.
- Flexible and adaptable to change.
- Ability to learn quickly and retain complex information.
- Travel to work assignments, appropriate individual automobile insurance must be maintained.
ESSENTIAL POSITION RESULTS
- Ability and desire to advocate for patients and help them achieve their best health.
- Flexibility and creativity in a newly-created role.
- Support hospital discharge planning, transfers, provide education regarding member benefits, and authorize post-discharge items as medically necessary.
- Identify barriers to efficient hospital utilization and facilitate resolution.
- Serve as a liaison between the hospital, health plan, vendors, and providers.
- Proactively and collaboratively, interface with clinics, HMOs, physicians, internal staff, members and their families to assist in expediting appropriate discharge.
- Refer members to various other departments (i.e., Case Management, Disease Management, and Complex Case Management) for follow-up as appropriate.
- Meet departmental review and documentation standards for work assignment.
- Manage individual market to determine opportunities to improve utilization, quality of care, access issues and physician profiling.
- Adhere to the policy and procedures of assigned hospital(s).
- Build and maintain appropriate relationships on behalf of Company
- Support a positive work environment and foster teamwork.
SUPERVISORY RESPONSIBILITIES - None
- Competent leadership and administrative skills.
- Flexibility and creativity – the program is in its first year and evolving.
- Good communication and customer relations’ skills; ability to work well with a team and independently.
- Utilization Management and Case Management experience, understanding and knowledge of healthcare benefits associated with various business lines (Medi-Cal, Medicare, and Commercial).
- Inpatient concurrent review, especially working with complex medical patients, including aged, blind, disabled.
- Ability to work independently in most instances, requiring limited supervision.
- Proficiency in computer operations, navigational skills and comfortable with Internet-based applications.
- Sound decision-making skills including problem solving, critical thinking, and good clinical judgment for clinical and non-clinical issues.
- Professional demeanor.