Transitions of Care RN, Bilingual Preferred

Role Overview

• Conducts behavioral or clinical assessments to identify individual member knowledge, skills and behavioral needs.
• Identifies and/or coordinates specific health coaching plan needs to address objectives and goals identified during assessments.
• Interfaces with provider and other health professionals to coordinate health coaching plan for the member.
• Implements and/or coordinates coaching and/or care plans by educating members regarding clinical needs and facilitating referrals to health professionals for behavioral health needs.
• Uses motivational interviewing to facilitate health behavior change.
• Monitors and evaluates effectiveness of interventions and/or health coaching plans and modifies as needed.
• Directs members to facilities, community agencies and appropriate provider/network.
• Refers member to catastrophic case management.

Requirements

• Requires AS in nursing and minimum of 2 years of condition specific clinical or home health/discharge planning experience; or any combination of education and experience, which would provide an equivalent background.
• Current unrestricted RN license in applicable state(s) required.
• RN compact license is highly preferred
• BS in nursing preferred
• Prior case management experience preferred
• Bilingual in Spanish is highly preferred
• Experience working with members that have chronic diseases is highly preferred
• Experience working in home health is preferred

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical, dental, vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources