Bravo Health, one of the fastest growing managed care organizations in the US, is a premier provider of Medicare Advantage plans, dedicated to offering senior citizens access to high quality, cost-effective health care.
Founded in 1996, Bravo Health provides health care plans to more than 300,000 members, in MD, DC, DE, NJ & PA as well as Part D Prescription Drug Plans in 43 states.
As a leading health services company, our mission is to create extraordinary value for our customers. Through our commitment to service and quality, we continually strive to be the preferred health care choice in each of the communities we serve.
As a result of our continued success, we currently have an opportunity available for an Acute Care Manager RN.
The Acute Care Manager (ACM) role [formerly the on-site discharge planner] performs the day- to-day on site functions of concurrent review and post discharge care coordination in his/her assigned hospital sites. This role requires multidisciplinary collaboration. The ACM reviewer monitors the utilization of care on-site by being proactively involved in chart review, through interactions with the covered beneficiary, attending and primary care physicians, care managers of the hospital, the Bravo Health (BH) Institutional Based (IB) program staff, BH Advanced Care Center (BHACC) hospitalists and the BHACC centers and discharge planning coordinators. Responsibilities may vary based on facility contract terms and assignment.
DUTIES AND RESPONSIBILITIES:
- Reviews the inpatient chart of every patient admission concurrently and based on the severity of the illness and intensity of the patient services in her/his assigned hospital.
- Refers cases and prepares for discussions/rounds with the Bravo Medical Director to assess and address appropriateness of the medical care rendered using relevant InterQual criteria and Medicare guidelines as appropriate.
- Notifies the Primary Care Provider (PCP) of admissions from his/her panel of members if the PCP is not the admitting physician in order to enhance the clinical information available to the PCP and the admitting physician.
- Notifies the Bravo Health Nurse Practitioner (NP) responsible for the care of the Institutional Based Bravo Health member admitted or discharged to/from his/her assigned hospital and receives additional necessary clinical information from the NP to expedite the care of the member.
- Collaborates with the attending physician or hospitalist when information obtained from the medical record review does not meet admission or concurrent review criteria and when discharge planning needs are identified.
- Interviews and completes Bravo Health Risk Assessment tool for members during inpatient stay based on member triage criteria e.g. Bravo members known to complex care at the BHACC, members at high risk of readmission, members hospitalized more than seven (7 days). Identifies and refers individuals based on risk assessment for case management.
- Monitors progress and readiness for discharge.
- Collaborates with facility care/case managers and applicable Bravo Health team members to prepare for safe discharge. Facilitates and coordinates discharge planning by ensuring the Bravo member has access to ordered alternate level of care placements (e.g. Rehab, SNF), durable medical equipment, home health, prescriptions, and follow up appointments to their PCP and the Bravo Health Advanced Care Center (ACC)as applicable.
- Completes system authorizations, documentation and updates as applicable. Issues or coordinates with the facility UM representative to issue notices of non-coverage and appeal rights as applicable.
- Prepares and participates in the BHACC interdisciplinary conference /rounds weekly at the applicable BHACC.
- Acts as the liaison between their assigned facility, Bravo Health, the BHACC , Bravo Hospitalists and the Bravo Health medical directors regarding census and for issues requiring intervention.
- Identifies coordination of benefit opportunities and identifies opportunities such as avoidable admissions, alternate levels of care, physician-member interventions and transition of care concerns.
- Assists the Manager/Management Health Services in communicating Bravo Health strategy or processes and resolving conflicts or issues between Bravo Health and their assigned facility.
- Facilitates the transfer of clinically stable members from non-contracted facilities to contracted facilities by contacting the member’s PCP or arranging with the Bravo Health medical director for a contracted provider to accept the transfer of care of the member.
- If needed, provide on call availability for Bravo Health admissions either to contract or non contracted facilities.
- Contributes and adheres to Bravo Health’s, a Health Spring company, overall mission, vision, and values statements.
- Participates in optional and mandatory in service training sessions.
- Performs other duties as needed by the Manager, Health Services.
- Minimum 2-3 years of acute adult/geriatric inpatient clinical experience; ICU/ED experience preferred AND minimum 1-2 years post-acute/home care or care coordination experience required
- Registered Nurse (RN) with active, unrestricted, current Pennsylvania license
- Proficient in using lap top computer using windows based software including MS Word
- Ability to learn medical authorization QNXT claims software
- Capability of working in a team-oriented, dynamic environment
- Ability to be flexible and adaptable in a fast paced work environment
- Previous health plan experience with concurrent review, discharge planning or care coordination preferred
At Bravo Health, we recognize and reward your knowledge, skills, experience and dedication to excellence with attractive compensation plans and an impressive benefits package that includes:
- Medical and dental insurance along with prescription and vision coverage
- Participation in a 401K plan with a company match
- A generous tuition reimbursement plan
- Company-paid, life and AD&D insurance as well as company-paid short-term and long-term disability coverage.
- Considerable Paid-Time-Off
If you are interested in learning more about how you can become part of our dynamic, high-growth organization that provides opportunities for our members and our employees to “Live Life Well”, we encourage you apply today