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Registered Nurse

Company: AmeriHealth Caritas
Location: Allentown
Posted on: June 14, 2019

Job Description:

**Transition Care Manager RN Lehigh Valley** Location: Allentown, PA Telecommuter?: Yes ID**: 16547 Your career starts now. We're looking for the next generation of health care leaders. At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at . **Responsibilities:** Under the Direction of the Supervisor, the Transition Care Manager is responsible for completing preventative multidisciplinary discharge planning for plan member presenting to the Emergency Room and / or Acute Setting using AmeriHealth Caritas policies and procedures. The Transition Care Manager will assess and processes discharge planning needs across all disciplines including necessary case management referrals. This position may include the following responsibilities: consistent application of medical health benefit policy and medical management guidelines to authorize services, appropriately identifies and refers requests to the Medical Director when guidelines are not met, review of daily ER or inpatient census of plan members, receive and process facility referrals, face to face interaction with plan members, complete survey to identify plan member needs, identify gaps in care, determine members understanding of illness and outpatient management of illness in addition to evaluating and coordinating and implementing discharge needs for all short and long term needs across disciplines including but not limited to PCP, home care, skilled nursing and rehabilitation services, DME, pharmacy, case management and/ or social worker referral for community needs and availability, scheduling appointments and arranging critical follow-up calls for care coordination, and member education on how and where to seek appropriate care and follow-up services. **Education/Experience:** + Bachelor's Degree. + Registered Nurse. + Registered Nurse, or Social Worker graduated from an accredited Diploma, Associates Degree or Bachelor's Degree program. + Minimum of 3 years nursing experience, in related clinical setting. + Managed care experience required. + Emergency room or acute discharge planning experience preferred. + An unrestricted RN or LMSW to practice in the Plan's state and any other state in which he/she works. + Proficiency with Microsoft Office Suite (Word, Excel, Power Point). Access is a plus. Consistent word processing speed and accuracy of 50 or more words per minute. EOE Minorities/Females/Protected Veterans/Disabled

Keywords: AmeriHealth Caritas, Allentown , Registered Nurse, Other , Allentown, Pennsylvania

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