Advanced Nurse Practitioner in Long-term Care
3 weeks ago
Job Summary:
We are seeking a highly skilled Nurse Specialist with experience in acute care settings to join our team at Yoh. As a Nurse Specialist, you will be responsible for performing clinical reviews of Skilled Nursing Facilities, Distinct Part Hospitals, and Intermediate Care Facility admissions and recertifications to validate the appropriate level of care.
Key Responsibilities:
- Perform clinical reviews of Skilled Nursing Facilities, Distinct Part Hospitals, and Intermediate Care Facility admissions and recertifications to validate the appropriate level of care
- Assess members referred to health plan programs for the identification, evaluation, coordination, and management of members' needs, including physical health, behavioral health, and social services
- Provide direction to non-clinicians who assist members with accessing services
- Conduct additional assessments as necessary to monitor, evaluate, and revise members' care plans to meet members' needs, with the goal of optimizing member health care across the care continuum
- Arrange for all services required while coordinating with the healthcare team to eliminate duplication of services
- Interface with Medical Directors, social workers, and interdisciplinary care team (ICT) members
- Participate in ICT meetings and make recommendations for LTC programs
- Maintain relationships with referral sources and community resources, such as external providers, SNFs, CBAS Centers, PMGs, and care coordinators, while maintaining strict member confidentiality and complying with all HIPAA requirements
- Facilitate care coordination with internal and external entities to improve members' short- and long-term goals in collaboration with members, caregivers, family, support systems, and physicians
- Document accurately and comprehensively based on the standards of practice and current organization policies
Requirements:
- Active and unrestricted California Registered Nurse (RN) License
- Minimum three (3) years of clinical nursing experience in an acute care setting required
- Minimum two (2) years of Managed Care experience preferred (HMO or IPA)
- Milliman Care Guidelines, (MCG), Managed Care and DHCS/NCQA experience preferred
- Excellent verbal and written communications skills
- Team player who builds effective working relationships
- Strong organizational skills
What We Offer:
- Medical, Dental & Vision Benefits
- 401K Retirement Saving Plan
- Life & Disability Insurance
- Direct Deposit & weekly EPayroll
- Employee Discount Programs
- Referral Bonus Programs
Yoh is an Equal Opportunity Employer.
We welcome all qualified applicants to apply.
Visit our website to learn more about our company culture and job opportunities.
Estimated Min Rate: $49.00
Estimated Max Rate: $70.00
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