Prior Authorization Rn Jobs in Washington (NOW HIRING)

Major Duties: Prepare monthly visit schedule prior to start of month. Gives copy to director of clinical services. Contacts patients with an appointment schedule.

On an Admission Visit:

1. RN receives the referral from the Director of Nurses / Director of Clinical Services. The RN will contact patient and/or family to arrange the date and time for the visit. RN completes assessment visit the designated time frame.
2. The RN assesses the patient’s needs and documents the findings of the complete physical assessment. The RN completes the admission documentation and contacts the physician for verbal orders and creates the plan of care.
3. The RN will turn in the admission documentation to the office within 48 hours on weekdays and 72 hours over the weekend. The RN will add the new admission to the caseload schedule. RN notifies patient/ family of the next scheduled visit. A calendar of future visits will be left in the home.
4. For DC EPD Waiver Beneficiaries R.N. to develop a plan of care for delivering PCA services that is consistent with the goals of the PCSP (PCA Oversight).

R.N.  to  manage  and  provide  supervision  to PCAs who are qualified to perform all of the functions of a PCA (PCA Oversight).

Accepting and reviewing the beneficiary's PCA Service Authorization and initial assessment or reassessment of need for PCA service

Developing a written plan of care in accordance with Section 5005 that meets the beneficiary's assessed needs and preferences  within  the service limitations authorized  in the PCA Service Authorization;

Developing a written plan of care in accordance with Section 5005 that meets the beneficiary's assessed needs and preferences  within  the service limitations authorized  in the PCA Service Authorization;

On a Follow up Visit:

1. The RN will contact the patient and/or family to remind them of the next scheduled visit.
2. The RN will perform a complete physical assessment, including vital signs on each visit. She/he will perform medication reconciliation on each visit. Notes will be turned in on weekly basis
3. Nurse will come into the office each week to complete documentation to ensure documentation is complete and meets the standards of Premier Health Services.
4. The RN will teach/ supervise the PCA/HHA as appropriate. The RN performs clinical supervisory visit on the skilled home health aide every 14 days, and the PCA at the monthly visit.
5. The RN may be required to perform more than one visit on a patient per month based on the number of PCA/HHA assigned to a patient, and when the patient condition requires extra visits.
6. The RN is required to perform an initial on-site teaching of the patient’s plan of care for any new permanent PCA/HHA assigned to a patient.
7. Performs medication reconciliation of each visit.
8. Makes post hospital visits to patients. Completes resumption of care and calls Physicians for discharge orders.
9. Updating each beneficiary's written plan of care based upon subsequent reassessments of need;
10. Reviewing the beneficiary's plan of care with each assigned PCA and ensuring that each assigned PCA has the requisite training, skills and ability to meet the beneficiary's identified  needs and preferences
11. Monitoring the quality of PCA services on a regular basis and ensuring that PCA services are delivered in accordance with the beneficiary's Plan of Care
12. Coordinating the provision of PCA services with other home health services, as appropriate and communicating with each beneficiary's physician or APRN regarding changes in the  beneficiary's  condition and needs
13. Gathering information regarding the beneficiary's condition and the need for continued care;
14. Communicating and coordinating with DHCF or its designated agent regarding changes in the beneficiary's condition and needs. At a minimum the Provider must communicate to DHCF or its designated agent:

1) Any failure or inability of the provider to deliver authorized service within three business days of  the scheduled  visit; and

2) Any change in the beneficiary's status requiring a modification in the amount, duration,                                              or scope of service authorized; and Counseling the beneficiary and the beneficiary's family  regarding nursing and related needs.

On all visits the RN:

1. Maintains accurate records of all services rendered to patients. She/he schedules visits according to the plan of care. Mandatory for notes to be turned into office Weekly.
2. Evaluates and regularly reevaluates the therapy and nursing needs of each patient. Make other referrals as appropriate.
3. Supervises and trains other nursing services personnel. Provides orientation to new personnel as appropriate.
4. Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors.
5. Order supplies for patients as need / approved.
6. Reports to the physician the patient’s response to treatments including drugs and changes in the patient’s physical or emotional condition. Documents these communications.
7. Performs medication reconciliation on each visit. Reorders medications as needed.
8. Interviews PCAs / HHAs and perform 90 days and annual evaluations.
9. Contacts case manager to update when condition changes.
10. Trouble shoots when there is no case manager.
11. Needs prior approval for PCA / HHA time off requests by RN nurse.
12. Completes recerts, transfers and discharges in a timely manner.
13. Demonstrates knowledge of medications and their correct administration based on age of the patient and patient’s clinical position. Gives patient / Caregiver educational handouts and reviews them together.
14. Collaborates with field supervisor and or Director of Clinical Services to resolve a patient complaints and or caregiver issues.
15. Teaches, supervises and counsels the patient and family members regarding the needs of the patient. Contacts the social worker/ case manager as appropriate.
16. Identifies and recommends to RN Field Supervisor increase / decrease PCA hours.
17. Participates in the Agency’s information management and performance improvement programs as requested.
18. Ensures that case conferences are done on each patient, recorded and filed in patient’s chart.
19. Adheres to dress code, appearance is neat and clean, wears ID badge at all times while on duty.
20. Completes annual education requirements
21. Maintains regulatory requirements.
22. Maintains patient confidentiality at all times.
23. Reports to work on time and as scheduled, completes work within designated time. Calls or Text Director of Clinical Services daily to receive messages during office hours.
24. Occasional weekend hours are required (at least one full weekend per month).
25. Nurses are required to be On-call based on the weekly On-call schedule.
26. Attends committee and management meetings, as appropriate. Attends all in-service and weekly nurses meetings.
27. Actively participates in performance improvement and continuous quality improvement activities.
28. Represents the organization in a positive and professional manner in the community.
29. Notifies the office of any change in schedule or missed visits immediately. A missed visit form will be completed after three attempts within the month and the visit rescheduled.
30. Discharges/ transfers patients according to agency policy. Completes OASIS documentation as appropriate.
31. Communicates the mission, ethics and goals of the organization.
32. Performs other job related duties as assigned.

Required Knowledge, Skills and Abilities:

1. Comprehensive knowledge of Home health theory and practice. Recent comprehensive patient assessment skills.
2. Demonstrated ability in supervision and leadership.
3. Ability to coordinate patients care services.
4. Able to communicate effectively in English, both verbally and in writing.
5. Additional languages desirable.

Education and Experience:  

1. Associates or bachelors (preferred) Degree in Nursing from an accredited nursing program.
2. Registered Nurse, currently licensed in The District of Columbia.
3. Homecare experience required with minimum of one (1) year in Home Health Care.

Physical and Environmental Condition:

Patient's home environments may involve risks or discomforts which require special safety precautions e.g. lifting, turning, transferring, assisting consumers when delivering nursing services and exposure to challenging physical and mental human behavior.

Office work environment involves everyday risks or discomforts that require normal safety precautions typical of such places as offices or meeting rooms, e.g., use of safe work place practices with office equipment, and/or avoidance of trips and falls.

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The above job description is not intended as, nor should it be construed as, exhaustive of all responsibilities, skills, efforts, or working conditions associated with this job. 

Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of this job.

Verification of Responsibilities:

Please sign the aforementioned job description as verification of responsibilities.  Your signature confirms that you have read and understand the duties outlined in this job: