At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers.
When you join 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!
JOB SUMMARY
The main responsibility will be to provide guidance and support to the Alianza CarePoint members during the transition of care process.
ESSENTIAL FUNCTIONS
- Identifies discharged members from the discharge census.
- Contacts the member to complete all the necessary assessments tools to guarantee the continuity of care and wellbeing of the patient physical and mental health and to assess if the member and, or caregiver understands the discharge care plan.
- Coordinates the PCP 7 days post discharge appointment.
- Contacts the member before to the appointment to remind it, and, after the appointment to confirm assistance, validate what was discussed and verify if the patient is stable.
- Identifies member’s needs and address them.
- Identifies medical issues or any barriers in care that may lead to re-admissions and discuss them with the PCP/Medical Director as appropriate.
- Acts as a liaison between the hospital discharge planning department and the insurance discharge planning unit.
- When necessary, follows up with the internal department in charge of the preauthorizations.
- Maintains effective communication with the member during the 30 days post discharge period.
- Provides guidance to the member and, or primary caregiver about the available resources to meet the identified needs.
- Documents all the interventions according to the department policies and procedures.
- Assists with necessary initiatives and activities to meet Alianza’s STAR and HEDIS measures.
EDUCATION
- Bachelor's Degree in Nursing
EXPERIENCE
- Bachelor’s Degree in Nursing Sciences (BSN).
- Minimum of one (1) to three (3) years of clinical experience.
Minimum of one (1) to three (3) years of managed care experience. - Current/ valid license in Puerto Rico Register Nurse without restrictions. Member of College of Nursing Professional of Puerto Rico.
LICENSES AND CERTIFICATIONS
- Current / Active Registered Nurse License without restrictions in Puerto Rico (required)
COMPETENCIES
- Action Oriented
- Collaborates
- Customer Delight (Employee)
- Instills Trust
- Manages Ambiguity
It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, 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 People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees.
We encourage Veterans and Disabled to Apply.