TOC Planner

Triple-S Management Corp.; Puerto Rico; On-site; USD 54,000 - 72,000; Full time

Job summary

Triple-S Management Corp. in Puerto Rico seeks a Registered Nurse to ensure smooth transitions for patients discharged from hospital settings. The role focuses on coordinating post-discharge care plans, educating members and families, and handling prior authorizations for needed services.

You will work with discharge planners, physicians, and care teams to arrange follow-ups, document care plans, and monitor outcomes to reduce readmissions and improve cost-effective care.

Qualifications

• BSN degree from an accredited program.
• 1–3 years of clinical nursing experience.
• Active RN license in Puerto Rico.

Responsibilities

• Coordinate post-discharge care plans with hospitals and providers.
• Arrange timely follow-up appointments with PCPs or specialists.
• Educate patients and families on discharge instructions and medications.
• Review and process prior authorization requests for post-discharge services.
• Ensure documentation is complete to expedite approvals.
• Support patients during transition from hospital to home or care setting.
• Communicate with providers and care teams to optimize transitions.

Skills

Care coordination

Discharge planning

Patient education

Education

BSN degree

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
• 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.