RN Onsite Inpatient Care Manager - Ashland, KY
Location: Ashland Kentucky
Description: WellCare is at the momment seeking for RN Onsite Inpatient Care Manager - Ashland, KY right now, this vacancy will be placed in Kentucky. Further informations about this vacancy opportunity kindly read the description below. -
1302726
About WellCare: WellCare Health Plans, Inc. provides managed care services targeted to government-sponsored health ! care programs, focusing on Medicaid and Medicare. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled, as well as prescription drug plans. The company serves approximately 2.7 million members nationwide as of Dec. 31, 2012. The company employs more than 4,500 nationwide. For more information about WellCare, please visit the company's website at www.wellcare.com. A Fortune 500 company traded on the New York Stock Exchange (symbol: WCG).
EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.
Description
Represents WellCare at assigned facilities to provide concurrent review, discharge planning and coordination and evaluates of members for Case Management needs during face-to-face interaction. Identifies members with high risk medica! l conditions that will require complicated medical treatments ! to refer for an individualized post-acute plan of care to reduce the risk of complications and/or re-admissions. Works collaboratively with providers and facilities to coordinate and authorize post-acute care services and will provide referrals to clinical and social support services, including but not limited to, case/disease management, other providers within the plan’s network and with community based resources.
Essential Functions:
Travels daily to assigned facilities to talk with members and physicians regarding the status and treatments within each case. Based on travel schedule and individual member’s situation, conducts onsite and/or telephonic concurrent review of members in assigned facilities to validate medical necessity of facility admissions.
Provides authorization to facilities using standard clinical criteria guidelines in conjunction with clinical judgement to determine the needed care required within the patient's individua! lized created care plan.
Initiates and continues direct communication with health care providers involved in the care of members, including treating physicians, IPA and/or hospitalists, to share information and collaboratively establish acute and post-acute treatment plans for hospitalized members.
Interacts with treating physicians and health plan medical directors to evaluate medical treatment plan, and assesses opportunities for optimizing clinical outcomes through referrals to specialty care programs or an alternate level of care.
Documents clinical updates, authorizations and referrals in the health plan medical management system adhering to health plan documentation standards.
Utilizing clinical judgement, assesses and evaluates members at risk for complicated medical comorbidities, and/or repeat admissions potential and determines individualized care plan for communication and interventions to promote successful discharge and post-! acute care treatment plan.
Conducts patient interviews and ass! essments through personal visits and using clinical judgement determines appropriate level of interventions and assess patient needs for follow up care.
Coordinates authorization and/or delivery of post-acute care services, including, but not limited to referrals to case and disease management, home health, medical equipment, skilled nursing facilities and other community based services.
Provides members with educational resources to enhance their ability to access health care services, including healthplan contacts, primary care physician and other pertinent health care provider contacts.
Facilitates referrals for post-discharge follow up with appropriate professional providers and support services (i.e. transportation) to ensure that members are able to access medically necessary services after discharge.
Complies with all health plan and facility based regulations regarding HIPAA and patient safety and security.
Identifies qua! lity of care issues, and reports to appropriate healthplan Quality department representative.
Performs special projects as assigned.
Additional Responsibilities:
Nurse will be based out of home, with travel required daily to assigned hospitals and facilities; Frequent travel required to regional healthplan office.
Valid driver’s license, without restrictions, is required.
Qualifications
Candidate Education:
Preferred A Bachelor's Degree in a related field Health Services or Nursing
Required Associates Degree in Nursing
Candidate Experience:
Required 3+ years of experience in general nursing with exposure in the following: E/R critical care, discharge planning, bedside care, and/or acute care facility.
Required 3+ years of experience in applying nursing judgement to make clinical decisions with minimal supervisory or oversight
Preferred 1+ year of experience in! Managed Care
Candidate Skills:
Intermediate Abilit! y to analyze information and covert related activities into a comprehensive work plan
Intermediate Ability to work in a fast paced environment with changing priorities
Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
Intermediate Ability to effectively present information and respond to questions from families, members, and providers
Intermediate Ability to create, review and interpret treatment plans
Intermediate Demonstrated written communication skills
Intermediate Ability to influence internal and external constituents
Intermediate Ability to represent the company with external constituents
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Demonstrated customer service skills
Intermediate Knowledge of healthcare delivery
Licenses and Certifications:!
Required KY RN License without restrictions
Technical Skills:
Required Intermediate Microsoft Excel
Required Intermediate Microsoft Outlook
Required Intermediate Microsoft Word
Required Intermediate Healthcare Management Systems (Generic)
Languages:
Required English
Preferred Spanish
Primary Location
KY-Ashland
Is a relocation package available?
No
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If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to WellCare.
If you interested on this vacancy just click on the Apply button, you will be redirected to the official website
This vacancy starts available on: Mon, 12 Aug 2013 23:50:41 GMT
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