RN Coordinator in Depew, NY

Salary Range: $88,000.00 - $94,000.00 per year

Pay: $88,000.00 - $94,000.00 per year

$5,000 Sign-On Bonus-The Registered Nurse (RN) Coordinator acts as the “eyes and ears” of the plan’s care management and utilization management team by communicating real time information about the member’s needs and helping to assure that the member is receiving the most effective care possible in the most appropriate setting. The ability to understand and value these two critical plan functions is essential to the role.

UM TASKS:
• May assist with utilization management, conducting utilization reviews for all Levels of Care and provide determinations within your assigned team.
• May assist with after-hour requests for non-emergent transportation including scheduling of trips with vendors and recording necessary data.
• Review potential Levels of Service coverage requiring, further discussion with Director of Utilization Management and Transitions, Director of ISNP and Clinical Services and/or CMO/Physician as indicated.
• Other duties as assigned.

TRANSITION TASKS:
• Oversight of Transitional Care Management across all SNP programs.
• Review of transition documentation within the EHR or Care Management Record to ensure the information documented is accurate and appropriate.
• May assist with documenting details of member transition in EHR or Care Management Record.
• Actively communicate with network partners regarding transitions.
• Receiving and documenting Transitions of Care for SNP Members within the Individualized Care Plan (ICP) ie. Inpatient, ER, Observation, and all planned and unplanned transitions.
• May send the Transitional POC documentation to the new and/or receiving care setting via fax.
• Ensure that all stakeholders (APP, SW, RN, CC) are aware of the transition with timely notification via phone, EHR or E-mail as appropriate.
• Review and communicate any missed first calls with the facility administrator, DON, and assigned PCPs.
• Communicate with member’s social worker and/or care manager to ensure that the member’s HCP and/or family member, as specified in the EHR, is aware of the transition of care.
• In the event of a planned Transition of Care Setting (SNF to hospital for scheduled procedure, admission of SNP member from community to SNF for rehabilitation), all notifications are done in advance as is practicable.
• Verify that all notifications specified above are documented in the member’s EHR.
• Advise health plan of prolonged or clinically intensive hospitalization per policy.
• Other duties as assigned.
QUALITY TASKS:
• Collaborate and act as a resource for quality and regulatory issues with the management team, clinical team, and other departments.
• May assist Care Managers (SW) or RNs or Care Coordinators with ICP development and compliance.
• Take part in the HCC Coding Accuracy Program process within assigned team with performing chart audits.
• May assist with the implementation of QIORs or action plan that improves the quality of care for our members when requested.
• Provide back up to department team members as needed.
• Provide weekend RN on call coverage in a rotation with other RN’
• Prepare quality review of transitions of members within assigned team in preparation for ISNP and CSNP IDT meeting or at request of management.
• Reviews and signs Individualize Care Plan (ICP).
• May visit assigned facilities or members on a pre-determined frequency or as indicated to monitor changes and acuity.
• Document visits and/or observations, as applicable, in the electronic medical record within company guidelines.
• Actively participate as a member of the Interdisciplinary care team (ICT).
• Conduct review of chart and member contact notes for informational gathering purposes if quality review is requested.
• May perform company audits/data collection and complete summaries per direct manager when requested/needed.
• May identify trends and areas for improvement within partnering facilities as the result of rounding/audits.
• May conduct informal facility staff education and teaching to ensure understanding of facility requirements and improve the effectiveness and efficiency of care delivery ie. first call training, UM requirements and billing, etc.
• Attend meetings assigned by management.
• Other duties as assigned.

Job Type: Full-time
Benefits: 401(k), 401(k) matching, Dental insurance, Employee assistance program, Flexible spending account, Health insurance, Life insurance, Paid time off

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, age, or national origin.

To apply, please apply via Quick Apply .