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Nurse Specialist

1 month ago

Alameda, California, United States Yoh Full time

Job Summary:

Nurse Specialist - Long-term Care Professional

Job Description:

We are seeking a skilled Nurse Specialist to join our team at Yoh. As a Nurse Specialist, you will be responsible for performing clinical reviews of Skilled Nursing Facilities (NF-A/B), 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 (NF-A/B), Distinct Part Hospitals, and Intermediate Care Facility admissions and recertifications
  • Responsible for performing assessments of members referred to health plan programs for the identification, evaluation, coordination, and management of members' needs
  • Provides direction to non-clinicians who assist members with accessing services
  • Conducts additional assessments as necessary to monitor, evaluate, and revise members' care plans to meet members' needs
  • Interfaces with Medical Directors, social workers, and interdisciplinary care team (ICT)
  • Establishes relationships with referral sources and community resources while maintaining strict member confidentiality and complying with all Health Insurance Portability and Accountability Act (HIPAA) requirements
  • Facilitates 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
  • Supports the Community Transition programs by evaluating identified institutional Members to determine if needs can be addressed through other avenues
  • Documents 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
  • Experience in a customer service or coordination in a healthcare setting or equivalent experience
  • Excellent verbal and written communications skills
  • Team player who builds effective working relationships
  • Strong organizational skills
  • Proficient experience in Microsoft Word, Excel, Access, Outlook, and PowerPoint

What We Offer:

  • Medical, Dental & Vision Benefits
  • 401K Retirement Saving Plan
  • Life & Disability Insurance
  • Direct Deposit & weekly EPayroll
  • Employee Discount Programs
  • Referral Bonus Programs