Overnight Prior Authorization Rn Jobs in Michigan

Employment Type:
Full timeShift:
Day Shift
Description:
This Triage Nurse role is full-time; 40 hours a week at our OBGYN Schoolcraft office.
Provides professional nursing care for patients following established standards and practices, which can include triage (telephone and walk-in visits), and care needs that transpire between office visits. The position ensures timely access to appropriate services, reduces care fragmentation, and promotes optimal health outcomes and patient safety. Demonstrates professional clinical leadership and oversight within the scope of the RN role.POSITION DESCRIPTION:
Provides professional nursing care for patients following established standards and practices, which can include triage (telephone and walk-in visits), and care needs that transpire between office visits. The position ensures timely access to appropriate services, reduces care fragmentation, and promotes optimal health outcomes and patient safety. Demonstrates professional clinical leadership and oversight within the scope of the RN role.
ESSENTIAL JOB FUNCTIONS:
The following job functions may not be the responsibility of all RN's. Some RN's will be assigned work that has more focused responsibilities (example: prior authorizations or indirect work supporting a provider inbox.)
1.Responsible for efficiently triaging patient needs via telephone and during visits to ensure appropriate timely access to the appropriate level of care, reducing avoidable emergency department visits and readmissions according to IHA's Policies and Protocols.
2.Conducts post-discharge calls for patients experiencing a transition of care for identified populations.
3.Documents clinical findings in a clear, concise and timely manner according to IHA Policy.
4.Utilizes critical thinking skills within the scope of licensure to appropriately assess patient needs and involves providers as appropriate.
5.Enters orders (medication, laboratory, radiology, referrals) according to provider direction and as per state, local and professional guidelines.
6.Follows clinical and nursing protocols as applicable.
7.Schedules patient appointments as applicable.
8.Encourages patient portal usage and supports where needed.
9.Provides scope-appropriate nursing education during all patient interactions.
10.Consults with providers and other extended care team members (Care Management, Embedded Pharmacy, Behavioral Health and Nutrition) and external case managers as appropriate to effectively ensure quality patient care.
11.Supports physician and advanced practice providers with indirect work according to protocol. This includes and is not limited to test results/orders management.
12.Assesses patients for gaps in care for preventative and disease management needs.
13.Ensures patient medication list is accurate, completes medication reconciliation and processes refill requests per protocol.
14.Works with the entire care team to co-manage indirect patient work according to Standard Work Instructions.
15.Collaborates with insurance, DME, home care and all other care partners to ensure patient needs are met.
16.Reviews patient medical history to identify supporting documentation relevant to ordered services and procedures to assist with or complete prior authorization process.
17.Assists patients with resources for any social influences of health needs.
18.Participates in process improvement projects within the office/department.
19.Serves as a resource to clinical office/department staff within scope of RN role; may direct the work of LPN and Medical Assistant staff as needed and appropriate based on role/scope.
20.May perform clinical support tasks as outlined on the Clinical Support Staff Scope of Practice document.
21.Supports other offices, attends required meetings and training, and participates in committees as requested.
22.Attends weekly patient care meetings and attends daily huddles as applicable.
23.Assumes additional duties as required.
ORGANIZATIONAL EXPECTATIONS:
1.Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the mission and values of Trinity Health Medical Group.
2.Must be able to work effectively as a member of the clinical care team.
3.Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
4.Successfully completes all relevant organizational training and adheres to Trinity Health Medical Group standard of care as outlined in the Trinity Health Code of Conduct.
5.Maintains knowledge of and complies with Trinity Health Medical Group standards, policies and procedures.
6.Maintains general knowledge of Trinity Health Medical Group office services and in the use of all relevant office equipment, computer and manual systems.
7.Maintains strict confidentiality in compliance with Trinity Health Medical Group and HIPAA guidelines.
8.Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities. Embraces new ideas and respects cultural differences.
9.Uses resources efficiently.
10.If applicable, responsible for ongoing professional development - maintains appropriate licensure/certification and continuing education credentials, participates in available learning opportunities.
MEASURED BY:
Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.
ESSENTIAL QUALIFICATIONS:
EDUCATION: Graduate of an accredited Registered Nurse program.
CREDENTIALS/LICENSURE: Valid, unrestricted RN license in the State of Michigan. Valid CPR certification.
MINIMUM EXPERIENCE: 1-2 years of clinical experience in a medical or physician office preferred. Previous nursing experience not required.
POSITION REQUIREMENTS (ABILITIES & SKILLS):
1.Demonstrated competency in obtaining accurate patient vital statistics (height, weight, blood pressure, temperature, etc.) and patient health history.
2.Must have basic knowledge and understanding as to the relevance of patient vital statistics to the patients' health history.
3.Proficient/knowledgeable in medical terminology.
4.Proficiency in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, email, e-learning, intranet and computer navigation. Ability to use other software as required while performing the essential functions of the job.
5.Excellent communication skills in both written and verbal forms, including proper phone etiquette.
6.Ability to work collaboratively in a team-oriented environment; displays courteous and friendly demeanor.
7.Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, providers, patients, vendors, family members, outside customers and community groups.
8.Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations.
9.Good organizational and time management skills to effectively juggle multiple priorities, time constraints and ever-changing medical situations.
10.Ability to exercise sound judgement and problem-solving skills.
11.Ability to perform mathematical calculations needed during the course of performing basic job duties, i.e.: calculating proper dosages for immunizations.
12.Knowledge of the compliance aspects of clinical care and patient privacy and best practices in medical office operations.
13.Ability to handle patient and organizational information in a confidential manner.
14.Ability to travel to other office/practice sites and meeting and training locations.
15.Successful completion of IHA competency-based program within introductory and training period.
MINIMUM PHYSICAL EXPECTATIONS:
1.Physical activity that often requires keyboarding, phone work and charting.
2.Physical activity that often requires time working on a computer.
3.Physical activity that often requires lifting over 50 lbs.
4.Physical activity that sometimes requires handling and lifting patients, transferring patients to gurney using slide board, assisting patients with dressing/undressing, transferring patients to wheelchair using gaitbelt, walking, bending, stooping, reaching, climbing, kneeling and/or twisting.
5.Physical activity that sometimes requires lifting, pushing and/or pulling up to 100 lbs.
6.Specific vision abilities required include close vision, depth perception, color vision, peripheral vision and the ability to adjust and focus.
7.Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
8.Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.
MINIMUM ENVIRONMENTAL EXPECTATIONS:
This job operates in a medical facility and requires regular walking to various locations around the hospital/clinic. Employees will be working where there is patient care equipment. Hazardous materials, including bloodborne pathogens and bodily fluids are also present. Exposure to sharps, x-rays, patients' conditions and some unpleasant sights, smells and contagious diseases are possible. This position requires significant interaction with people (many of whom are scared, hurt and/or ill) which can be stressful and result in competing priorities.
EMPLOYEE ACKNOWLEDGEMENT:
I acknowledge that I have reviewed this job description and I understand and can perform the essential functions and other requirements of the position, with or without accommodation. Any request for an accommodation must be made to Human Resources within 182 days of knowledge (or reasonably should have known) of the need for an accommodation. I agree that if there is anything in the job description that I do not understand, I will seek clarification from my supervisor or the Human Resource Department. I understand that IHA has the right to revise this job description at any time.
I acknowledge that IHA is an at-will employer which means that either I or the company can terminate the relationship at any time. This job description does not supersede the at-will status and does not constitute an employment contract for any specified period of time.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.