Rn-hospital to Home Star+plus

2 weeks ago

Houston, United States Harris Health System Full time

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

- Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
- Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
- Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
- Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

**Skills / Requirements**:
**JOB SUMMARY**

Under the supervision of the Director or designee, the registered nurse provides holistic, longitudinal, individualized member care in response to identified needs of low and moderate risk members. This position focuses primarily on the post-discharge calls made to members to optimize their safety and quality outcomes.

**JOB SPECIFICATIONS AND CORE COMPETENCIES**
- Provides and documents post-discharge call attempts and connections; escalates clinical needs quickly and closes all loops; advances complaints and grievances quickly and to the appropriate resource to ensure compliance with regulatory grievance requirements. Ensures member¿s record, including Plan of Care is corrected or updated as needed. Ensures member has opportunity to ask questions and gain clarity on care plan and requested follow-up activities and care regimen.
- Engages in evidence-based best practices that enhance the member experience, including participating in interdisciplinary care team meetings as appropriate.
- Actively contributes to achievement of departmental goals, as identified in Department¿s annual business plan, including specific departmental process improvement plans, and other duties as assigned.

**MINIMUM QUALIFICATIONS**:

- Education/Specialized Training/Licensure: Graduate of an accredited school of Professional Nursing.
- RN Licensure active in the State of Texas required.
- BSN Program preferred.
- Work Experience (Years and Area): 1 year experience in health plan setting.
- Software Proficiencies: Microsoft Office
- Other: N/A

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