Transitional Care Management Registered Nurse

TRANSITIONAL CARE MANAGEMENT RN

Jericho Road Community Health Center is actively seeking a Transitional Care Management (RN) . This position is a full-time, within the Nursing Department, working across sites Barton, Broadway, and Doat. Primary location is Barton Street.

Work with a Purpose

Jericho Road Community Health Center offers the opportunity to be engaged in a movement far larger than any one individual. We believe that we can all be people of positive influence. We influence each other, our clients and patients, our families and communities. We are part of a global team that influences the health and wellbeing of communities internationally. Every day, Jericho Road's mission of caring for communities and advocating for systemic health equity guides us in our collective purpose. We are looking for individuals who share that goal and are committed to that service. As a federally qualified health center (FQHC), our organization's mission is deeply rooted in making fundamental change in the communities we serve, advocating for social justice and meeting people where they are. With global clinics across the world, the impact you make will transcend borders, with opportunities to engage in meaningful work at our Sierra Leone, Goma or Nepal global clinics.

Why Jericho : Jericho Road offers competitive pay and benefits including medical (single-high coverage paid in full by employer), HSA, dental, vision, employer paid life insurance benefit, supplemental insurances, tuition discounts, generous paid time off, the opportunity for global travel to our three global health clinics, and loan forgiveness for applicable positions. Jericho Road values both work and life. The option for a flexible 40-hour workweek is possible within certain teams.

Responsibilities :

• Follow-up with notification of admission and / or discharge to / from an ER, hospital, residential, or rehabilitative setting to assure follow-up appointments are scheduled, ordered medications have been received, and other needed services are in place and provided to avoid gaps in care.
• Provides Transitional Care Management services post discharge from emergency room, acute inpatient or post-acute inpatient stays.
• Collaborate with Jericho Road care management team for support while transitioning between care settings.
• Assess patients for care management services after a referral has been made based on the admission screening and referrals for potential patient issues.
• Assures that patients are placed on appropriate self-management plans and protocols, individualizes client care needs through consultation with the multidisciplinary team.
• Work in collaboration with insurance companies, specialists, and other departments at JRCHC to ensure continuity of care for positive patient outcomes.
• Provides education on seeking medical attention early or using urgent care services when appropriate versus an emergency room.
• Provides telephonic engagements to clients on a worklist to meet standards of engagement to include both timing, frequency, and duration of engagements.
• Continues own education by keeping his / her knowledge current and conducts independent research of commercial plan guidelines to strengthen general understanding of state and federal resources to support position responsibilities.
• Ensures compliance with departmental policies and procedures, with special emphasis on compliance with HIPAA privacy and security requirements and all state, federal and plan regulatory mandates.
• Works with patients and providers to enhance the quality of client management and satisfaction.
• Performs appropriate assessments and develops client-directed care plans within health plan required timeframes and per NCQA standards.
• Regularly reviews and updates care plans for continuity of care and facilitates plan modifications including barriers to goals.
• Documents all interventions and telephone encounters with providers, members and vendors in accordance with established documentation standards.

Qualifications :

Hourly Rate : $35-$38 an hour. Individual compensation is based on various factors unique to each candidate, including skill set, experience, qualifications, and other position related components.

Job postings are not intended to be an exhaustive list of duties. You will be expected to perform different tasks as necessitated or required by your role within the organization and the overall missional objectives of the organization.

Jericho Road is an Equal Opportunity Employer. We are an inclusive organization and actively promote equity of opportunity for all.