GA – Telecommute
Nurse Coach- (Remote-Georgia)
Job Locations: Remote
Job ID: 2019-7017
Category: Clinical / Post Acute Care
Do you want to make a difference and help patients heal and age at home? As a Nurse Coach, you will utilize your clinical expertise to manage assigned Post-Acute Care patients’ transition from acute care setting to the home setting through telephonic outreach to provide education, coaching and care coordination to accomplish the goals of the Post-Acute Care Program
Engages Post-Acute Care patients in the program and administers initial assessments, progress surveys and discharge surveys in an effort to prevent readmissions.
Engages Post-Acute Care patient in the program and performs assessments that directly tie to reducing readmissions. These include but are not limited to: Educating members regarding their Discharge Instructions, ensuring a follow-up PCP appointment is in place, medication reconciliation, educating on the signs and symptoms of their condition, referral to community resources and caregiver support.
Works closely with the Post-Acute Care patient home health agency nurse, and physicians to facilitate education and adherence to establish health care goals and care plan.
Using clinical expertise, reviews utilization information concerning patient care and matches those needs to available care options, within the Post-Acute Care Program and specific plan payer criteria.
Documents all interactions, guidance and interventions in applications
Acts as a clinical resource for Post-Acute Care Coordinators, assisting to clarify referral source directives. Receives/responds to requests from unlicensed staff regarding scripted clinical questions and issues.
May support on-going reauthorization decisions for Post-Acute Care patients and issues service reauthorizations for the home care provider based on medical necessity and payer benefit guidelines.
Contacts referral sources to advise them of referral status. Relays referral status and updates to the assigned health plan case managers.
Participates in and contributes to ongoing quality assessment/improvement activities, ensures the collection of data for improvement analysis and prepares reports as requested.
Typical work schedule is Monday thru Friday 8am to 6pm. Based on business needs, evening (8pm-8am) and weekend (8pm-6am) coverage may be needed at times.
Registered Nurse with licensure in the state(s) of practice required.
Expertise in Telephonic Case Management and knowledge of URAC standards
Broad knowledge of health care delivery/managed care regulations, contract terms/stipulations, prior Case Management/review experience, and governmental home health agency regulations required.
Excellent negotiation, communication, problem-solving and decision-making skills also required.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.
Medical & Health , Case Management , Nursing