Especailista En Transicion De cuidado

GENERAL DESCRIPTION: Responsible for identifying and managing discharged insureds in the Classicare business line. Responsible for coordinating the needs of discharged insureds from all business lines.

ESSENTIAL FUNCTIONS

•Identifies discharged insureds who apply to the transitional care program (who do not have heart failure (CHF), have an active case in complex care management, or have been readmitted, LOB Classicare). Shall performs a transitional care assessment to identify needs no later than in the established period after the discharge.

•Establish a care plan with specific goals based on the Transitional Care assessment results and the risk level present. This plan includes but is not limited to coordinating visits within the established period of the discharge, reviewing medications and adherence to treatment, coordinating all services needed at the time of discharge, identifying the contact person during the thirty days that the patient will be active in the program, and resolving potential treatment limitations.

•Conducts follow-up interventions through telephone calls, according to the patient's level of risk, and closes the case in the established period. •Coordinates, with the corresponding Clinical Unit, the referrals necessary to implement services related to the patient's needs. •Evaluates and determine if the requested discharge coordination services proceed according to the patient's clinical needs and Medicare guidelines.

•Discusses with the Medical Advisor the cases to be discharged that do not meet the medical need to offer services that the patient may need. Determines the action plan to follow. •Complies with production, quality, and timing standards as per applicable regulations. •Meets the quality standards of the Special Needs Program (SNP).

ADDITIONAL FUNCTIONS:

• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS

Education and Experience

Bachelor's degree in Nursing Sciences with at least three (3) years of experience in clinical areas and documenting or analyzing medical records. Certifications / Licenses: A valid Nurse Association Nursing Professionals of Puerto Rico License and Registration is required. Other: N/A Languages: Spanish – Intermediate (comprehensive, writing and verbal) English – Intermediate (comprehensive, writing and verbal)