Job Description

Company Overview

Advanced Management USA is a leading ACO consulting firm committed to improving care coordination, optimizing provider relationships, and driving Medicare cost savings through the ACO model. Our mission is to enhance patient outcomes, streamline post-acute care, and build strong provider networks that align with value-based care principles to Skilled Nursing Facilities, Home Health, Hospitals, Hospice, and Therapy at Home groups.

We are seeking a Registered Nurse (RN) Post-Acute Care Coordinator to manage post-acute relationships, oversee care transitions, and ensure compliance with CMS policies. This role is critical in improving patient care coordination, enhancing quality outcomes, and ensuring patients receive the right care at the right time. The Post-Acute Care Coordinator collaborates with care management teams to facilitate seamless transitions and optimize care delivery.

Key Responsibilities

• Monitor and track patient movement across facilities to ensure efficient and appropriate post-acute care.
• Advocate for patients, ensuring seamless transitions and high-quality care.
• Ensure compliance with federal, state, and local guidelines
• Facilitate timely discharges by collaborating with Hospitals, SNF staff, physicians, and home health providers.
• Ensure compliance with the 3-day SNF Rule Waiver as applicable to the ACO track guidelines.
• Work with various teams and case managers to ensure seamless patient transitions from SNFs to home or alternative care settings.
• Develop and maintain strong relationships with SNFs, hospitals, and home health agencies to align with ACO objectives.
• Lead virtual meetings with administrative leadership to improve care coordination and transition planning.
• Facilitate collaboration on ACO policies, discharge best practices, and quality reporting requirements.
• Serve as the primary liaison between Advanced Management USA, SNFs, and other post-acute care facilities.
• Analyze and track SNF length-of-stay data to identify cost-saving opportunities and improve patient transitions.
• Collaborate with case managers and providers to implement Medicare cost-reduction strategies.
• Monitor key performance indicators (KPIs), such as hospital readmission rates, length of stay, and total cost of care, to drive continuous improvement.
• Assist in the development of performance reports to assess facility utilization and patient care trends.
• Ensure adherence to ACO program guidelines and regulatory requirements.
• Implement quality improvement initiatives to enhance patient outcomes and provider efficiency.
• Maintain accurate records of patient progress, provider interactions, and care transitions.

Qualifications & Requirements

• Registered Nurse (RN) license required.
• Minimum 3 years of experience in Skilled Nursing Facility (SNF), Home Health, Case Management, or Post-Acute Care Coordination.
• Strong understanding of ACO models, Medicare regulations, and care transitions.
• Experience with electronic health records (EHR) and patient tracking systems.
• Excellent communication, negotiation, and problem-solving skills.

Preferred Qualifications

• Experience working in an ACO or value-based care setting.
• Certification in Case Management (CCM) or Care Coordination.
• Knowledge of Medicare, population health management, and 3-day SNF waiver programs.

Compensation & Benefits

• Competitive salary based on experience.
• Health, dental, and vision insurance.
• 401(k) with company match.
• Paid time off.
• Professional development opportunities in ACO consulting and value-based care models.

Why Join Advanced Management USA?

At Advanced Management USA, we are committed to reshaping post-acute care delivery through innovative ACO consulting and care coordination strategies. By joining our team, you will play a key role in transforming patient care, improving SNF efficiency, and driving cost savings for Medicare. If you are a dedicated RN with SNF experience and a passion for care coordination, we encourage you to apply!

Apply today to be a part of a team that is making a real impact in healthcare transformation!

Advanced Management USA is an equal opportunity employer and drug-free workplace. All employment is contingent upon successful completion of a drug screen, background check, reference verification, health assessment, and credential/license verification.

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