Prior Authorization Rn Jobs in Pennsylvania (NOW HIRING)

Description

POSITION SUMMARY
The Infectious Disease Specialty Clinic RN works to promote health, prevent disease and assist physicians, and extenders with patient needs by reinforcing physicians' and extenders' instructions. The ID Specialty Clinic RN must honor the Commonwealth of Pennsylvania's guidelines on licensing. The position is responsible for coordination and implementation of PA Department of Health STD Program, the Hepatitis C clinic, infectious disease consults and the HIV/ Ryan White clinic. All communication, including privacy and security of patient protected health information, HIPAA, must be exercised at all times. A multi-disciplinary approach to care is utilized. The RN helps develop and maintain an environment that supports the staff within the Patient-Centered Medical Home.

REPORTING RELATIONSHIPS

This position reports to the collaborating physician and the Program/ Service Line Director.

ESSENTIAL JOB DUTIES AND FUNCTIONS 

While living and demonstrating out Core Values, the ID Specialty Clinic RN will: 

• Works with the medical director of Infectious Disease to ensure a high-performing and innovative patient-centered medical home environment.
• Implements standing orders.
• Coordinates clinical team activity toward patient-centered care.
• Demonstrates the ability to respond appropriately to emergencies.
• Maintains clinical skills by performing the following duties when needed:
• Uses a variety of standard medical equipment to perform medical procedures or examinations on patients.
  • Performs focused physical assessment through vital signs and interview while assigning them to an exam room when a Medical Assistant is not available.
  • Triages scheduling events based on acuity of signs and symptoms described.
  • Prepares, administers and records medications and treatments as ordered by physicians.
• Assures all information is captured in electronic medical records.
• Completes all required or requested patient forms.
• Provides patient education and health coaching.
• Triages all patient phone calls and provides consultation in a considerate and respectful manner.
• Develops long-term plan of care and periodically assesses continuity.
• Monitors and responds to EMR patient portal communications in a timely manner as needed.
• Obtains prior authorizations on medications and procedures as needed.
• Exercises HIPAA confidentiality and security measures at all times during office hours and outside the office.
• Demonstrates responsibility for self-learning through participation in continuing education activities and conferences.
• Participates in Total Quality Improvement reviews and activities in the clinical setting.
• Serves as a clinical resource for staff, learners, patients and families.
• Ensure patient needs are met by providing quality chronic care management
• Performs other duties as directed by Management.

PA DOH STD Program:

• Counsel patients and obtain consent for testing
• Create a risk reduction plan for each patient
• Perform post-test counseling
• Specimen collection, processing, labeling and packaging; arrange for UPS pick-up
• Maintain drug inventory and submit required reports and supply orders
• Submit required monthly logs
• Read all DOH memos regarding the program, correspondence, statistics, billing and results
• Reconcile and submit monthly charges
• Chart inspection for completeness
• Assist with DOH STD program inspection
• Submit any required reporting

Hepatitis C:

• Screen all Hep C consults and referrals 
  • Assure appropriate information and documentation is received
• Assist with submission of medication prior authorization.
• Send medication prescription to the correct insurance pharmacy
• Confirm with patient receipt of medication and start date
• Act as a couch during treatment
• Order all lab work based on physician protocol and monitor and track results
• Place reminder calls to non-compliant patients or no-shows
• Prepare and enter data on the Hep C Care Workflow Sheet

Infectious Disease Consults:

• Screen all consults
  • Assure appropriate information is received
• Complete info sheet with attached incoming referral
• Contact referring physician's office for additional information in needed
• Send completed referral to ID Physician for review
• Assist with scheduling patients for appointments

HIV Clinic:

• Screen all HIV referrals
  • Assure appropriate information and documentation is received
• HIV teaching and therapy preparation
• Work with the DOH on referrals and coordination: o Patients out of care
• Reengaged in care
• New Diagnosis
• Send medication prescription to the correct insurance pharmacy
• Confirm with patient receipt of medication and start date.
• Act as a couch during treatment
• Order all lab work based on physician protocol and monitor and track results
• Place reminder calls to non-compliant patients or no-shows
• Prepare and update HIV Pink Sheet
• Updated HIV History tracking

Designated Infection Control Officer:

• Actively participate in the infection control committee meetings
• Direct and assist in preparing reports and statistical data for the infection control committee, and quality and safety committee
• Conduct ongoing review of infection control policies, procedures and guidelines to identify infection control discrepancies and implement revisions as necessary
• Provide information to the quality and safety committee and department managers to formulate changes in the policies, procedures and/or processes which could reduce the spread of infection
• Assist in the development and coordination of the infection prevention and control program throughout the health center. Implements the program by formulating, establishing and evaluating policies and procedures relating to patient care infection control measures throughout the health center
• Perform an annual assessment and develop action plans from the prior year activities.
• Make recommendations regarding construction, renovation, environmental rounds, and assures compliance with national and/or professional standards
• Investigate incidents and actively participate in follow up root cause analysis and PDSAs

Requirements

• BS Degree in Nursing
• Registered Nurse in the state of Pennsylvania 
• Registered Nurse with 2-4 years' experience in healthcare environment
• CPR/ACLS certified
• Knowledgeable of the CDC and OSHA Guidelines
• Ability to work reliably, with professionalism in a high-volume, high-demand medical practice environment.
• Proven above average performance as an RN
• Good organizational and prioritization skills
• Ability to work independently and with a team
• Excellent written and oral communication skills
• Must be a relationship-builder, superior patient advocate, and a self-motivated problem-solver
• Knowledge of electronic medical records