Admission and Discharge RN

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Oversee discharge care coordination, episodic case management, and counseling for pre-admission and post-discharge in relation to acute conditions.

• Build rapport with members during the immediate follow-up after discharge or until all short-term care needs are fulfilled.

• Deliver educational resources and local information to members while promoting self-education.

• Assess the complexity of cases and refer to other internal departments as necessary.

• Collaborate with physicians, coordinators, and facility discharge planners to identify additional resources and appropriate case dispositions.

• Execute ongoing functions to assist members in the transition of care process, which may include: a. Consulting with physicians, providers, members, and other resources as needed to assess, plan, implement, coordinate, monitor, and evaluate options and services tailored to meet individual acute health requirements, utilizing communication and available resources to enhance quality health outcomes.

• Customize outreach and engagement based on member attitudes, behaviors, and risk assessments. Coordinate care with providers to address risks or newly identified conditions.

• Reconcile medications, educate, and monitor adherence to ensure safety.

• Reinforce post-operative care instructions regarding diet, activity levels, and other care requirements.

• Identify and address obstacles to attending follow-up appointments with the appropriate provider and assist with appointment scheduling.

• Aid members in locating a primary or specialist provider, a Blue Distinction Center, or facilitate necessary coordination with Customer Service.

• Provide face-to-face interventions on-site in select cases.

• Offer education and suggestions to mitigate conditions and risks, supporting behavior change and self-management.

• Collaborate with both the provider and member to formulate alternative care plans as necessary.

• Assist members and providers in navigating the healthcare system effectively.

• Evaluate cases for quality-of-care concerns and refer cases to the QA/QI department for assessment and follow-up.

• Conduct Transition of Care services for all assigned lines of business.

• Operate within the limits of licensure.

• Act as a preceptor for the orientation of new hires.

• Uphold licensure and enhance knowledge of designated licensure areas and regulatory standards through attendance at seminars and training sessions.

• Engage and communicate professionally and effectively with colleagues, management, customers, and other stakeholders.

• Adhere to HIPAA regulations, Diversity Principles, Corporate Integrity, Compliance Program policies, and other relevant corporate and departmental policies.

• Ensure complete confidentiality of company information.

• Maintain ongoing communication with management regarding developments in assigned responsibilities and undertake special projects as requested.

⛳️ Requirements

• Must be a Registered Nurse (RN) or Licensed Master Social Worker (LMSW) with a current, active, unrestricted license in the state of operation (or have reciprocity where applicable).

• Minimum of 2 years of clinical experience required.

• At least 1 year of experience in health insurance or managed care is necessary.

• Familiarity with medical management policies and procedures is required.

• Proficient in PC and database usage.

• Strong verbal and written communication skills are essential.

• Excellent customer service and interpersonal skills to effectively discuss pre/post admission care with physicians, hospital staff, and members.

• Must be able and willing to travel occasionally within the assigned location, possessing transportation and a current, valid driver’s license for the applicable state.

• Individuals holding nursing licenses in positions requiring multi-state licenses must secure and maintain additional current, valid, and unrestricted nursing licenses in other states as determined by management. Multi-state license fees will be covered.

🏝️ Benefits

• Comprehensive health insurance plans.

• Retirement savings options.

• Opportunities for professional development and continuing education.

• Flexible work arrangements.