Primary Responsibilities

The NPST Lead RNCC partners with the Texas Independence Health Plan Institutional Special Needs Plan (ISNP), to provide support to all NPST RNCC, for all Regions. Functions as a Case/Care Manager and patient healthcare navigator for Texas Independence Health Plan Members within nursing facilities. Manages one facility caseload of patients remotely.

 

Essential Function

Provides oversight of Hedis/Care seed, offer tips and tricks to RNCCs Review medication refill spreadsheet and submit all medication refills when due. Digs into medical non-adherence reasons, provide feedback to Regional COM. Troubleshoots specialist issues, provide feedback to Regional COM. Helps with PA’s, issues provisional authorization (PA) as needed. Monitors MTM’s progress. Participates in RNCC interviews. Trains new RNCC’s, mentors established RNCC’s Subject matter expert of TIHP benefits and processes Filter for RNCC issues. Brings to Regional manager what cannot be troubleshoot Reminds RNCC’s to do monthly death report and monthly visit reports. Runs weekly RNCC meetings. Covers vacancies when needed. Primary RNCC for one facility caseload remotely Assist the Plan NP with care coordination duties and documentation on Plan Members. Obtain a daily Plan Member census evaluation, documenting and reporting to Plan NPs which Plan Members were transferred out of the Facility (to the Emergency Department or for Hospitalization), who has elected Hospice Care, and who has returned from the Hospital in the past 24 hours. Partner with facility staff and other members of the Interdisciplinary Care Team (ICT) to implement care plans for Plan Members and identify and assist in the coordination of specialty or ancillary services, therapy, and/or other referral needs. Monitor Plan Members experiencing changes of condition, transitions to and from the hospital or other healthcare environment by working in coordination with facility staff to stay in touch with the hospital for updates and informing the Plan NP of the Plan Member’s hospitalized status. Ensure that the Plan Member’s discharge paperwork and summary are received by the Plan NP. Follow-up timely with each Plan Member after a transition to ensure that the Plan Member is not at risk for a readmission and to inform the Plan NP of any possible medical or other needs the Plan Member may have. Alert the Plan NP promptly of new enrollees and place urgency on the Plan NP’s intervention if the Plan Member is at risk for transition at any time. Perform all other duties congruent with the ISNP Plan as assigned.