Nurse Specialist - Long-term Care
Category: Healthcare
Employment Type: Contract
Reference: BH-378646
(WFH) Nurse Specialist Registered Nurse (RN) needed for a remote contract opportunity with Yoh's client located in Alameda, CA!
Top Skills You Should Possess:
- California RN License required
- Clinical Nursing Experience in Acute Care setting
- Managed Care experience (HMO or IPA) strongly preferred
What You'll Be Doing:
- Performs clinical review of Skilled Nursing Facilities (NF-A/B), Distinct Part Hospitals and Intermediate Care Facility admissions and recertifications to validate the appropriate level of care.
- Responsible for performing assessments of members referred to health plan programs for the identification, evaluation, coordination, and management of members' needs, including physical health, behavioral health, and social services.
- 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, with the goal of optimizing member health care across the care continuum.
- Interfaces with Medical Directors, social workers, and interdisciplinary care team (ICT). Participates in ICT meetings and makes recommendations for LTC programs.
- Establishes 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 Health Insurance Portability and Accountability Act (HIPAA) requirements.
- Facilitates care coordination with internal and external entities to improve member's short- and long-term goals in collaboration with member, 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, such as community services, HCBS and covered health plan benefits, and makes referrals to appropriate programs.
- Documents accurately and comprehensively based on the standards of practice and current organization policies.
- Performs other duties as assigned.
What You Need to Bring to the Table:
- 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's In It For You?
We welcome you to be a part of the largest global staffing companies to meet your career aspirations. Yoh's network of client companies has been employing professionals like you for over 65 years in the U.S., UK, and Canada. Join Yoh's extensive talent community that will provide you with access to Yoh's vast network of opportunities.
- Medical, Dental & Vision Benefits
- 401K Retirement Saving Plan
- Life & Disability Insurance
- Direct Deposit & weekly EPayroll
- Employee Discount Programs
- Referral Bonus Programs
What are you waiting for? Apply Now!
Recruiter: Arlet Khachikyan
Yoh makes finding and applying for jobs simple. Partner with Yoh to find the right opportunities across multiple industries in the US and UK.
Estimated Min Rate: $49.00
Estimated Max Rate: $70.00
Note: Any pay ranges displayed are estimations. Actual pay is determined by an applicant's experience, technical expertise, and other qualifications as listed in the job description. All qualified applicants are welcome to apply.
Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Visit https://www.yoh.com/applicants-with-disabilities to contact us if you are an individual with a disability and require accommodation in the application process.
For California applicants, qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. All of the material job duties described in this posting are job duties for which a criminal history may have a direct, adverse, and negative relationship potentially resulting in the withdrawal of a conditional offer of employment.
