TOC Planner

Triple-S; Guaynabo (PR); On-site; USD 60,000 - 75,000; Full time

Job summary

Triple-S in Puerto Rico seeks a Registered Nurse to ensure seamless post-discharge transitions, coordinating care plans, education, and follow-up with providers. This role conducts prior authorizations for post-discharge services to support cost-effective care.

You will collaborate with discharge planners, physicians, and home health teams, arrange DME, monitor outcomes, and communicate clearly with members and families to promote adherence.

Qualifications

• BSN required with 1–3 years of clinical experience.
• Active RN license in Puerto Rico.
• Experience in discharge planning or care coordination is a plus.

Responsibilities

• Collaborate with hospital discharge planners and providers to develop post-discharge care plans.
• Coordinate timely follow-up appointments with primary care or specialists.
• Educate members and families on discharge instructions, medications and warning signs.
• Review and process prior authorization requests for post-discharge services.
• Arrange home health services, DME, or rehabilitation as needed.
• Maintain clear communication with members, providers, and internal teams.
• Monitor outcomes and participate in quality improvement initiatives.

Skills

Nursing

Care coordination

Discharge planning

Patient education

Education

Bachelor's Degree in Nursing

Job description

At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers.

When you join 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.

Job Summary

Responsible for ensuring a seamless transition for members being discharged from hospitals to their next level of care. This role involves coordinating post-discharge care plans, providing education and support to members and their families, and conducting prior authorizations for necessary services. The goal is to improve patient outcomes, reduce readmissions, and ensure cost-effective care delivery.

Essential Functions

• Collaborate with hospital discharge planners, physicians, and other healthcare providers to develop comprehensive post-discharge care plans.
• Coordinate and ensure timely follow-up appointments for the member with their primary care providers or specialists.
• Educate members and their families about discharge instructions, medication management, and signs of potential complications.
• Review and process prior authorization requests for post-discharge services, including medications, therapies (home health), medical equipment (DME), among others.
• Ensure all required documentation is complete and accurate to expedite the authorization process.
• Arrange for necessary home health services, durable medical equipment (DME), or rehabilitation services.
• Provide support to members during their transition from hospital to home or another care setting and educate members on the importance of follow-up care and adherence to prescribed treatments and medications.
• Maintain clear and effective communication with healthcare providers, members, and internal teams and participate in interdisciplinary team meetings to discuss and optimize care transitions.
• Monitor and evaluate the effectiveness of care transition plans and authorization processes and identify areas for improvement and participate in quality improvement initiatives to enhance patient outcomes and service efficiency.

EDUCATION

• Bachelor's Degree in Nursing

Experience

• Bachelor's degree in nursing (BSN), with 1 to 3 years of clinical experience.
• Active Registered Nurse (RN) license from Puerto Rico.

COMPETENCIES

• Manages Ambiguity
• Instills Trust
• Collaborates
• Customer Delight (Employee)
• Action Oriented

It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, 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 People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees. We encourage Veterans and Disabled to Apply.