Job Description

Founded as a single health plan in 1984, Centene Corporation (Centene) has established itself as a national leader in the healthcare services field. Today, through a comprehensive portfolio of innovative solutions, we remain deeply committed to delivering results for our stakeholders: state governments, members, providers, uninsured individuals and families, and other healthcare and commercial organizations. Centene's core philosophy is that quality healthcare is best delivered locally. Our local approach enables us to provide accessible, high quality and culturally sensitive healthcare services to our members. Our managed care model utilizes integrated programs that can only be delivered effectively by a local staff, resulting in meaningful job creation within the communities we serve.Job DescriptionIntro:We are aggressively seeking a RN Field Healthcare Transition Coach a Healthcare organization. As the Year 2016 is in full swing, this organization is very busy, and they need YOUR help.Take advantage of flexible hours, a competitive salary, and be a RN Field Healthcare Transition Coach with one of the fastest-growing healthcare companies in the U.S. Get in NOW, while there is still huge room for growth and career development!This exciting opportunity will require a RN Field Healthcare Transition Coach who can provide a high level of service and attention to their members. If you are seasoned, and you meet the qualifications listed below, please send your updated resume to Ana Bayolo for immediate consideration.Daily Responsibilities:Candidate will be working remote. Will be interviewing training at the Bothell address listed in order.70% of time will be in the field. All equipment provided as well as mileage reimbursement.Knowledge/Skills/AbilitiesCoordinates transition of care between inpatient and other settings with the practitioner, Healthcare Services (HCS) staff, and community based agencies, social workers, hospital/nursing facility discharge planner, and/or other providers as required.Coordinates necessary services with participating ancillary service providers and public agencies as appropriate to ensure quality, cost effective care and reduced readmissions for the member.Conduct one discharge planning hospital visit with the member at assigned facilities prior to discharge to:Discuss the Molina Transition of Care ProgramIdentify staff and roles as they differ from the facility staffIntroduce Personal Health Record (PHR)Review Discharge ChecklistEvaluate current medications via the medical record or advise the member to request that facility staff review the medication listDiscuss the importance of understanding prescribed medications and having a system in place to ensure adherence to the regimenDiscuss the Medication RecordFacilitate appointment with either the Primary Care Physician/Practitioner or treating specialist within 5 days of dischargeProvide information and contact numbers for Molina resources (transportation, Nurse Advice Line (NAL), Care Coordination/Case Management, Behavioral health)Discuss emergency planDevelops a plan of care consistent with sound medical, behavioral health, chemical dependency and financial management. Includes assessment of health needs, individualized care plans and/or service plans, implementation, monitoring and evaluation of case outcomes.Arranges for health care services within the scope of available benefits.Documents medical management within the electronic medical record system. Documentation includes assessments, service plans and/or care plans and updates, contacts and planned tasks.Reviews and updates care plans for continuity of care and facilitates plan modifications including barriers to goals and interventions for members being coached through the transition of care from the inpatient and or skilled nursing facility.Maintains active caseload and conducts expected face to face visits consistent with Molina Healthcare standards.Documents a cost analysis of services. Contributes to monthly departmental Cost Savings Report and decreased readmission rates for the populations served.Maintains department quality standards, including inter-rater reliability (IRR) testing and quality review audit scores.Attends meetings related to care coordination and HCS Department topics.Provides coverage for other staff as needed.Performs mentorship, assisting leadership in coordination of work, quality review, etc. Involved in program development and process improvement activities for the department.Other duties as assigned.Complies with workplace safety standards.Other Duties and Skills (secondary importance)Knowledge of a variety of clinical areas of medical treatment. Experience with Managed Care population preferred.Knowledge of hospital/patient care facilities, current practices, procedures, acceptable medical treatment and diagnoses.Knowledge of home and community based services.Ability to promote self-management.Ability to work within several systems of care.Comfortable making home visits.Skill in establishing and maintaining a variety of records necessary to provide complete information and documentation for relevant and appropriate medical determination.Skill to establish and maintain effective work relationships with those contacted in the performance of required duties.Other duties as assigned.Must have a courteous manner and positive attitude when interacting with employees and customers.Demonstrated adaptability and flexibility to changes and response to new ideas and approaches.Demonstrates professionalism at all times.Ability to independently use resources to solve problems.Effective and culturally sensitive communication skills with individuals and families from diverse ethnic and cultural backgrounds.Bilingual based on community need.Ability to motivate members to be active participants in their health.Knowledge of applicable state, federal and third party regulations and standards (Medicare, Medicaid, Copes, MPC, SSI).Comfortable working with Aged, Blind, Disabled, and Severely Mentally Ill populations with varied economic and educational circumstances.Maintain member respect and dignity while displaying maturity, empathy, ethics, confidentiality and professionalism.Provide health education and advocacy to members and their families.Must have a high regard for confidential information.Ability to work in a fast paced environment.Works independently and as part of a team.Computer and Microsoft Office experience.Accurate data entry at 40 WPM minimum.Skilled at identification and elimination of barriers to receiving services.Broad knowledge of area community resources/agencies.Ability to develop and execute plans of care and prepare reports as needed or requested.PreferredPrevious Managed Care Experience.Certified Case Manager (CCM), Certified Professional in Healthcare Management Certification (CPHM) or other healthcare or management certification.Training, Transition of Care, TOC, Management.HH.Best CandidateRN from another Managed Care Company working in the field with ABD/LTC population coordinating services/transitioning care.RN from the HOSPITAL/HH facility that are doing 'Case Management' type of duties coordinating care, community outreach programs etc. who has the discharge planning experience as well.Hours for this Position:Monday – Friday 8:00am – 5:00pmAdvantages of this OpportunityFun and positive work environmentWant More Information?Interested in hearing more about this great opportunity? Reach out to Gemma Halton at407-478-0332 ext. 153QualificationsRequirements:Active unrestricted state of Washington RN licenseStrongly prefer a BSN but a combination of an AA degree and good experience will also work.Minimum two years Medical Case Management experience.Minimum one year Public Health experience (Public health is any position that is creating healthy communities through education, research and promotion of healthy lifestyles. In public health, the focus is on health promotion and disease/injury prevention, in contrast to the medical model of care, which focuses more heavily upon diagnosing and treating illnesses and conditions after they occur).Knowledge or experience transition patient/member care.Must have at least a year of hospital discharge planning experience (Concurrent Review).Additional InformationCompetitive salary, negotiable based on relevant experience.Benefits offered: Medical, Dental, and Vision.J-18808-Ljbffr

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