Care Management Nurse - Tss

Care Management Nurse

Guaynabo, PR

ABOUT US

At Grupo Triple S, we are committed to provide meaningful job experiences for Valuable People (Gente Valiosa). We encourage an environment of very high ethical standards, always excelling in service, collaboration among the company, agility to deliver timely, and embracing accountability for results.

When you join Grupo Triple S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.

Let's build healthier communities together, join now!

ABOUT THE ROLE

Responsible for organizing, coordinating, and oversight care management services to patients within the handling chronic conditions that includes, but is not limited to: performing health risk assessment (HRA), planning, implementation and assessment of the needs, barriers and services of high risk and cost of members under these medical conditions to develop an individualized care plan (ICP). Monitor the different stages of health of the special needs population (SNP). Effectively coordinates the services necessary to maintain an optimal level of health of the high-risk patient and facilitate access to medical care services.

WHAT YOU'LL DO

• Develops and implements transition of care for patients in conjunction with hospital-based care managers.
• Report adverse drug events / opioid utilization that have been experience by the patient according to company standards.
• Assess and refer patients for special program/services when appropriate.
• Develop and participate in health education activities, promotion of the disease management, patient training workshops, conferences and community presentations, if required.
• Other tasks as assigned by management and that are essential.
• Complete and submit all tasks and paperwork within timeframe defined by standard operating procedures.
• Support member in their representative regarding care, care transition and changes in health status.
• Performs telephone, email, fax and/or face to face interactions to determine needs for continued care.
• Responsible for good housekeeping techniques adhering to quality and production standards while complying with all applicable company, state and federal standards.
• Communicate patient benefits and responsibilities timely and accurately.
• Provide coordination in caseload to ensure all elements and tasks are completed timely and ensure cases move through the process as required.
• Responsible providing communications to patient’s healthcare providers other Triple S-Salud representatives and external stakeholders.
• Obtain input from providers, patients and family as appropriate, and evaluates and revises the plan as needed.
• Collaborates in a patient care process to assess, plan, facilitates, coordinate, monitor and evaluate options and services that meets member’s needs.
• Analyze patient variances from the plan and initiates the appropriateness steps to resolve discrepancies.
• Implements a comprehensive clinical care management plan for each patient.
• Perform quality checks and report trends to leadership and during interdisciplinary care team meetings accordingly.
• Documents the progress of the condition of the member and all the arrangements made using the electronic application within the work plan and the electronic health record, according to the policies and procedures established.
• Responsible for handling cases, while interfacing with key stakeholders (internal/external) to ensure optimal care management.

WHAT YOU'LL BRING

Bachelor’s Degree in Nursing with one (1) to three (3) years of clinical experience. Current/ valid license in Puerto Rico Register Nurse, in Good Standing or without restrictions. Member of College of Nursing Professional of Puerto Rico.

CLOSING DATE: 05/01/2023

It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, gender, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.

Equality Employment Opportunity/Affirmative Action for Minorities/Females/People with Disabilities/Veterans”. Employer with E-Verify to verify the eligibility of employment of all the new employees.

We encourage Females, Veterans and Disabled to Apply