Integrated Transitional Care Nurse, Lvn

3 weeks ago

Rancho Cucamonga, United States Inland Empire Health Plan Full time

**What you can expect**

Find joy in serving others with IEHP We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an **authentic experience**

Join the dynamic Integrated transitional Care team, directed by our visionary leaders As an integrated Transitional care Nurse LVN, you’ll collaborate with hospitals and Independent Physician Associations to ensure seamless, quality healthcare for our low and rising-risk members. From conducting risk assessments to coordinating transitions and conducting reviews, you’ll play a pivotal role in preventing readmissions. Be at the forefront of healthcare innovation, liaison between various stakeholders and ensuring effective communication.

**Major Functions (Duties and Responsibilities)**

1. Conduct Integrated Transitional Care discharge risk assessment on low and rising risk Members.
2. Perform concurrent and retrospective reviews for per evidenced based criteria, appropriateness of service and level of care, either through Telephonic review, clinical documentation submitted by respective facilities and/or electronic medical records (EMR) access.
3. Conduct reviews to ensure that Member’s treatment plan is consistent with Diagnosis(es), specifically initial review within twenty-four (24) hours to ensure Member’s meet specified criteria for the respective admission(s).
4. Work in collaboration with the coordinator to ensure timely arrangements for transitions to higher or lower level of care and assist with transfer orders as needed.
5. Ensure that the concurrent or retrospective review process included referring cases that require clinical consultation with the RN in a timely manner.
6. Ensure cases are appropriately referred to Care Management, Behavioral health, Health Education, Housing, community health.
7. Identify outliers and preparing documentation as well as report on potential quality of care issues as identified.
8. Serve as the IEHP Liaison between hospitals, IPAs vendors, outside agencies and provider to ensure effective communication and collaboration in an effort to meet the Member's treatment plan and goals.
9. Oversee verification of delivery of ordered Durable Medical Equipment (DME), Health Home visits, set up hospital follow up visits with PCP, and transportation needs.
10. Oversee and complete of Discharge planning assessment.
11. Outreach to Member post discharge to ensure Member attended follow up appointment, Health Home started visits, arrange in-home visit by RN or assigned LCSW as appropriate.
12. Generate additional follow up needed to assign to appropriate regional Behavioral Health & Care Management team.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

**Perks**

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.
- Competitive salary.
- Hybrid schedule.
- CalPERS retirement.
- State of the art fitness center on-site.
- Medical Insurance with Dental and Vision.
- Life, short-term, and long-term disability options
- Career advancement opportunities and professional development.
- Wellness programs that promote a healthy work-life balance.
- Flexible Spending Account - Health Care/Childcare
- CalPERS retirement
- 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance

**Education & Requirements**
- Two (2) or more years of Utilization management/case management in a health care delivery setting in Acute or Skilled nursing, with an emphasis on Concurrent Review and Utilization management.
- Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians required.

**Key Qualifications**
- Knowledge of evidence based clinical criteria and California Children Services (CCS).
- Must have analytical skills. Excellent communication, interpersonal and organizational skills.
- Self-starter and a team player. Time management, and problem-solving abilities. Must have a high degree of patience.

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