Posted: Sunday, September 3, 2017 1:07 PM
About SynerMed SynerMed is a market:leading healthcare organization specializing in government:sponsored programs headquartered in Monterey Park, California. SynerMed is dedicated to innovating healthcare through an integrated system of tools, purpose:built web platforms, and professional services that connect physicians, members, hospitals and health plans. SynerMeds mission is to transform the healthcare system by rewarding high:quality and cost:effective care. For more information about SynerMed, visit and Follow SynerMed on:TwitterYouTubeLinkedIn The Care Transitions Nurse will be part of a multi:disciplinary team of clinical partners who will be responsible for identifying and coordinating planning care needs for targeted members. The Care Transitions Nurse will function with a collaborative team to strategist and focus on the implementation of efficient coordination of services with goal to prevent illness while managing episodic and chronic health problems. Under the direct supervision of the Clinical Integration Manager, the Care Transitions Nurse will be responsible for managing an assigned network to develop strategies including but not limited to ER Diversion, IP/OP case management and discharge planning needs and to assist members in accessing care/services to avoid preventable illnesses which results in over utilization.Work with the medical staff and Director to develop analysis of medical and encounter data to forecast and/or recommend changes in process to improve engagement of targeted high acuity members.Develop mechanism to identify targeted high acuity members and/or family caregivers and initiate care coordination planning with goal of directing coordinated care.Engage targeted high acuity members and/or family caregivers and initiate discharge planning with goal of directing coordinated care.Evaluate members using standardized assessment surveys to obtain key information to develop appropriate care planning needs.If targeted member is admitted, work with hospital case management staff and/or discharge planners if needed in order to elicit cooperation and improve outcome in discharge planning coordination.Analyze clinical and non:clinical data obtained from medical records and/or from member/family interview and determine immediate referral needs to ancillary or specialty services.Coordinate discharge planning needs with the Clinical Integration Team along with Inpatient CM and CCM department to avoid duplication of care.Be able to identify problem areas, develop solutions accordingly and determine favorable outcomes that can be used to support future care coordination protocols.Prepare reports of eligible members for discussion with CIM and/or Clinical Integration Team.Report directly to Clinical Integration Director and provide input on day to day operations.Clinical experience and ability to multi:taskMust have computer skills and desire to learn the medical and business side of managed careMust be able to document all electronic, telephonic, or written communication in the performance of the case management processMust have an active, unrestricted and valid California LVN or RN License.
• Location: Inland Empire
• Post ID: 138503742 inlandempire