Integrated Transitional Care Nurse, RN

2 days ago

Rancho Cucamonga, California, United States Inland Empire Health Plan Full time
Job Title: Integrated Transitional Care Nurse, RN

At Inland Empire Health Plan, we are committed to delivering high-quality healthcare to our members. We are seeking a skilled and compassionate Integrated Transitional Care Nurse, RN to join our team.

About the Role:

The Integrated Transitional Care Nurse, RN will play a critical role in ensuring seamless transitions between care settings for our high-risk members. This position requires strong analytical and communication skills, as well as the ability to work collaboratively with various departments and stakeholders.

Key Responsibilities:
  • Conduct comprehensive discharge risk assessments for high-risk members to identify potential care gaps and develop targeted interventions.
  • Oversee and perform concurrent and retrospective reviews to ensure medical necessity and appropriateness of care.
  • Collaborate with the care coordination team to ensure timely arrangements for transitions to higher or lower levels of care.
  • Identify outliers and prepare documentation to report potential quality of care issues.
  • Process timely completion of denials and ensure compliance with regulatory requirements.
  • Serve as the IEHP liaison between hospitals, IPAs, vendors, and providers to ensure effective communication and collaboration.
  • Oversee verification of delivery of ordered DME, Health Home visits, and hospital follow-up visits.
  • Perform medication reconciliation and outreach to members post-discharge to ensure follow-up appointments and Health Home starts.
Commitment to Quality:

The IEHP team is committed to incorporating IEHP's Quality Program goals, including HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits:

As an IEHP employee, you will enjoy a range of benefits, including CalPERS retirement, 457(b) option with a contribution match, generous paid time off, and access to a state-of-the-art fitness center on-site.

Qualifications:

To be successful in this role, you will need:

  • Two or more years of Utilization Management/Case Management experience in a healthcare delivery setting.
  • An active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN.
  • Excellent analytical, communication, and interpersonal skills.
  • A high degree of patience and ability to work in a fast-paced environment.
Work Model Location:

This position is on a hybrid work schedule, with Monday and Friday remote workdays and Tuesday through Thursday on-site workdays in Rancho Cucamonga, CA.

Pay Range: $58.13/Hr.

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