Inpatient Clinical Nurse

Guaynabo, PR

ABOUT US

At Grupo Triple S, we are committed to provide meaningful job experiences for Valuable People (Gente Valiosa). We encourage an environment of very high ethical standards, always excelling in service, collaboration among the company, agility to deliver timely, and embracing accountability for results.

When you join Grupo 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!

ABOUT THE ROLE

Independently performs tasks guided by policies, clinical guidelines, and procedures. Selects the best methodology to achieve the outcomes identified in a work plan or project. Responsible for collecting inpatient data, analyzing and interpreting it, and making recommendations to be used by others at a higher hierarchical level for decision making.

WHAT YOU'LL DO

• Visits participating hospitals and health centers to determine if records meet established clinical criteria guidelines for admissions and any other required audits, documents relevant recommendations.
  
• Identifies assigned enrollees from the hospital census and enrolls them in the Inpatient Clinical Program.
  
• Documents the clinical review of each audit in the electronic system, meeting established quality standards.
  
• Performs Admission Assessment of all assigned patients during the first 72 working hours of admission to the hospital.
  
• Primary responsibility will be to provide guidance and support through an individualized plan to all insured persons admitted to the Inpatient Clinical
• Program with a multidisciplinary team.
  
• Ensures that all required services are coordinated on or before 48 hours of discharge in a safe and efficient manner in accordance with evidence-based clinical best practices.
  
• Completes discharge assessments for all assigned patients preferably on the same day of discharge or up to 24 hours after discharge and ensures coordination of primary care physician appointment 7 days after discharge.
  
• Review of continued stay, proactive discharge planning, transition of care for our patients.
  
• Evaluate readmissions to identify same or related diagnosis.
  
• Works directly with social worker and discharge planning to ensure coordination of services at discharge.
  
• Identifies and refers potential events to various cost containment programs, continuing to follow up on events as appropriate.
  
• Discusses adverse determination with the company Utilization Review Manager/Supervisor, Medical Advisor, Hospital Coordinator or Treating
• Physician. Notifies the Company Medical Advisor's final decision to the Hospital Coordinator or Treating Physician.
  
• Notifies hospital of closed admission events reviewed according to established process.
  
• Participates in the weekend scheduling program.
  
• Other duties as assigned by management and as essential.

WHAT YOU'LL BRING

Bachelor’s Degree (BD) in Nursing Sciences with one (1) to three (3) years of clinical experience, preferable in hospital environment. Current / Active License in Nursing without restrictions in Puerto Rico. Member of College of Nursing Professionals of PR.

CLOSING DATE: 05/19/2023

It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, gender, 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 Minorities/Females/People with Disabilities/Veterans”. Employer with E-Verify to verify the eligibility of employment of all the new employees.

We encourage Females, Veterans and Disabled to Apply