Under the Direction of the Supervisor, the Transition Care Manager is responsible for completing preventative multidisciplinary discharge planning for plan member presenting to the Emergency Room and / or Acute Setting using AmeriHealth Caritas policies and procedures. The Transition Care Manager will assess and processes discharge planning needs across all disciplines including necessary case management referrals. This position may include the following responsibilities: consistent application of medical health benefit policy and medical management guidelines to authorize services, appropriately identifies and refers requests to the Medical Director when guidelines are not met, review of daily ER or inpatient census of plan members, receive and process facility referrals, face to face interaction with plan members, complete survey to identify plan member needs, identify gaps in care, determine members understanding of illness and outpatient management of illness in addition to evaluating and coordinating and implementing discharge needs for all short and long term needs across disciplines including but not limited to PCP, home care, skilled nursing and rehabilitation services, DME, pharmacy, case management and/ or social worker referral for community needs and availability, scheduling appointments and arranging critical follow-up calls for care coordination, and member education on how and where to seek appropriate care and follow-up services.
* Unrestricted PA Registered Nurse graduated from an accredited Diploma, Associates Degree or Bachelor's Degree program * Minimum of 3 years nursing experience, in related clinical setting. * Managed care experience required. * Emergency Room or Acute Discharge Planning experience preferred. * Familiarity with electronic record and documentation programs. * Proficiency with Microsoft Office Suite (Word, Excel, Power Point) and internet applications. Access is a plus. Consistent word processing speed and accuracy of 50 or more words per minute.