Long-Term Care Nurse Specialist RN

(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.  Arranges for all services required while coordinating with the health care team to eliminate duplication of services. 
• 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.  A person-centered approach will minimize member confusion and ensure that the best care is delivered in the most appropriate setting. 
• 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.  
• Constant and close visual work at desk or computer.
• Constant sitting and working at desk.
• Extensive data entry using keyboard and/or mouse.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Occasional travel to hospitals and other facilities.
• Frequent lifting of folders and other objects weighing between 0 and 30 lbs.
• Frequent walking and standing.
• Occasional driving of automobiles.
• Occasional travel between offices for meetings.

  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

Any pay ranges displayed are estimations which may have been provided by job boards.   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.
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.

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.