General Purpose: The individual holding this position is required to support and demonstrate their commitment to the Longevity Health Statement of Purpose, which is: To improve the health and quality of life of nursing home residents by caring for their unique medical, social, and emotional needs.
The ISNP Registered Nurse Care Coordinator (RNCC) is an essential member of the Clinical Operations team providing support to the market based clinical teams to facilitate access to member needed services and supports. The RNCC will facilitate seamless member access to out of nursing facility services through direct communication with Health Axis and field market teams on member needs for in network and out of network services. The RNCC will facilitate timely completion of single care price agreements, out‐of‐ network approvals, access to care needs. Additionally, the RNCC will follow up on Prior Authorization requests to ensure timely notification. This role will manage the monthly Advanced Practice Provider assignment communication process working together with the Utilization Management team and the market clinical leaders. The RNCC manages all care transitions requirements for members discharging to home. The RNCC will support weekly market hospitalization review meetings and facilitate documentation of follow up actions.
Key Tasks and Responsibilities:
- Works directly with the clinical team to identify member external appointments, then facilitates access to those providers in a seamless and timely manner.
- Performs care coordination activities ‐ member transitions of care to and from facility, assisting with Prior Authorization requests, members’ needing out of Nursing Facility care and services, knowing how to access the drug formulary, provider directory and communicates member patients/families and doctors as delegated by team Advanced Practice Providers.
- Participates in Longevity Health Plan standing clinical meetings on a daily/weekly monthly basis.
- Assists with managing hospitalization review sessions, taking notes and sending follow up actions.
- Based on trends, identifies out of network opportunities for contracting and communicates to designated network resource.
- Performs other duties as assigned, or as required by the team and based on caseload, workload, etc.
Credentials & Coverage:
- Licensed registered professional nurse.
- Valid state driver’s license with a good driving record and proof of automobile insurance required.
- Auto liability insurance coverage per minimum required by home state.
Education, Training/Certification:
- Registered professional nurse, prefer in one of our current states.
- A minimum of a 2‐year associate degree as a registered nurse required but BSN is preferred.
- CCM preferred, but not required.
Knowledge and Experience:
- Must have at least one (1) year of actual nursing home or equivalent experience.
- 3‐5 years’ experience as a Registered Nurse.
- ISNP or managed care/value‐based payment program case management experience strongly preferred.
- Excellent verbal and written communication skills.
- Ability to work in a team‐based environment and balance workload.
- Knowledge of the challenges and opportunities to serve the long‐term nursing home population.
- Required to have managed care coordination background/experience.
Company Overview:
Founded in 2018, Longevity Health started as an Institutional Special Needs Plan (ISNP), a type of Medicare Advantage health plan that addresses significant unmet needs of long-term institutionalized members who reside in nursing homes. Through rapid growth from 2018 to 2022, we expanded our market footprint and currently offer ISNP Medicare Advantage plans in Colorado, Florida, Illinois, Michigan, New Jersey, New York, and North Carolina.
In 2023, we expanded our service offerings to the broader health plan market. In addition to our existing markets where we are both the ISNP and the care management team, we are now partnering with National Carriers on their offered ISNP plans in Ohio, Pennsylvania, upstate New York, Georgia, South Carolina, and Texas, with implementations in progress for several other additional US states. This allows us to utilize our core skills of supporting clinical post-acute needs of this vulnerable senior population Currently 13 markets and expanding rapidly.
Company Disclaimers:
Longevity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.
It is the policy of Longevity Health to follow Federal and / or State regulations surrounding COVID vaccinations. While CMS guidelines have been relaxed, there are some LHP facilities which will still require staff be vaccinated in an effort to protect the health of the members / patients we serve. If your assigned location(s) require all staff to be fully vaccinated, you are required to obtain and / or provide documentation related to your COVID vaccination. To confirm whether your assigned location(s) require COVID vaccinations, please refer to the Facility Guide Job Aid located on Longevity Health Plan’s intranet site.
The Company will engage in an interactive process with individuals who cannot be vaccinated for medical or sincerely held religious beliefs to determine if a reasonable accommodation can be made. While an exemption/accommodation may be initially granted, if at any time during employment, it is determined that an exemption/accommodation that has been granted is no longer considered a reasonable accommodation, it can result in employment with the Company ending.
Candidates must meet the Company’s hiring criteria which include a pre-employment background and drug screening.
Longevity Health offers a competitive compensation and benefits package which includes medical, dental, vision, short and long-term disability, life insurance, and 401(k).
Submission of false information during the application process may result in immediate termination of employment without notice.