The Nurse Coach utilizes clinical expertise to manage assigned Post-Acute Care patients' transition from acute care setting to the home setting through telephonic outreach to provide education, coaching and care coordination to accomplish the goals of the Post-Acute Care Program.
Engages Post-Acute Care patients in the program and administers initial assessments, progress surveys and discharge surveys in an effort to prevent readmissions.
Engages Post-Acute Care patient in the program and performs assessments that directly tie to reducing readmissions.These include but are not limited to: Educating members regarding their Discharge Instructions, ensuring a follow up PCP appointment is in place, medication reconciliation, educating on the signs and symptoms of their condition, referral to community resources and caregiver support.
Works closely with the Post-Acute Care patient home health agency nurse, and physicians to facilitate education and adherence to establish health care goals and care plan.
Using clinical expertise, reviews utilization information concerning patient care and matches those needs to available care options, within the Post-Acute Care Program and specific plan payer criteria.
Documents all interactions, guidance and interventions in applications
Acts as a clinical resource for Post-Acute Care Coordinators, assisting to clarify referral source directives. Receives/responds to requests from unlicensed staff regarding scripted clinical questions and issues.
May support on-going reauthorization decisions for Post-Acute Care patients and issues service reauthorizations for the home care provider based on medical necessity and payer benefit guidelines.
Contacts referral sources to advise them of referral status. Relays referral status and updates to the assigned health plan case managers.
Participates in and contributes to ongoing quality assessment/improvement activities, ensures the collection of data for improvement analysis and prepares reports as requested.
Participates in an annual Inter-rater reliability Testing Process
Typical work schedule is Monday thru Friday 8am to 6pm. Based on business needs, evening and weekend coverage may be needed at times.
Associate's or Bachelor's Degree in Nursing and licensure in the state(s) of practice required.
Minimum of 5 years of experience as a Registered Nurse
Expertise in Case Management and knowledge of URAC standards
Broad knowledge of health care delivery/managed care regulations, contract terms/stipulations, prior Case Management/review experience, and governmental home health agency regulations required.
Excellent negotiation, communication, problem solving and decision making skills also required.