Transitional Care Specialist

About the role

This position identifies and manages discharged insureds in the Classicare business line and coordinates the needs of discharged insureds across all business lines. It is a regular, exempt role focused on transitional care.

Key responsibilities

• Identify discharged insureds applying to the transitional care program (those without heart failure, no active complex care case, and no readmission).
• Perform a transitional care assessment to identify needs within the established period after discharge.
• Establish a care plan with specific goals based on the assessment and risk level, including coordinating visits, reviewing medications and adherence, coordinating discharge services, identifying the contact person for the first 30 days and resolving treatment limitations.
• Follow up by telephone calls according to the patient's risk level and close the case within the established period.
• Coordinate referrals with the Clinical Unit to deliver services related to patient needs.
• Evaluate whether discharge coordination services meet clinical needs and Medicare guidelines, and discuss with the Medical Advisor cases that do not meet medical need.
• Comply with production, quality and timing standards, and with company policies, local and federal laws and industry regulations.

Required profile

• Bachelor's degree in Nursing Sciences with at least three years of experience in clinical areas and in documenting or analyzing medical records.
• Valid Nurse license and registration with the Puerto Rico Nursing Association.
• Intermediate Spanish and English, comprehensive in writing and speaking.