Prior Authorization Rn Jobs in Rochester, NY (NOW HIRING)

$5,000 Full-time Registered Nurse Sign-On Bonus!

Job Summary

The Nurse Coordinator provides health care oversight and medical case management for an identified caseload of youth/individuals.  This role may also include performing all clinical functions of a Registered Nurse (RN). 

This is a full-time (40 hours) salaried position, on a Monday-Friday, day shift schedule.

Essential Job Functions

• Understand and adhere to all federal, state, and local statutes, regulatory agency standards and Hillside policies including but not limited to Office of Mental Health (OMH), Office of Child and Family Services (OCFS) regulations, Office of People with Developmental Disabilities (OPWDD), New York State Education Department NYSED), and Council on Accreditation (COA).
• Develop and deliver coordinated health services in accordance with professional practice as part of an interdisciplinary team.
• Develop, supervise implementation of, review and revise each individual's written health care plan.  
• Provide education to staff, youth, families, and community providers on relevant health topics to ensure proper care and follow-up.
• Monitor and respond to patient movement, including referral, admissions, health care and discharge and provide discharge summary establishing health care follow-up.
• Attend admissions pre-placements to obtain medical/psychiatric history, establish health care needs, and complete prior authorization for medications or medical necessity based on recommendation from the individual's medical providers.
• Advocate on behalf of youth/individuals to establish appropriate health care. 
• Consult and coordinate with outside providers or other members of the participant's health care team to follow-up on physical or psychiatric medical concerns and implement follow-up care recommendations. 
• Communicate effectively and professionally with the individual's parent/guardian to ensure family driven care is delivered. 
• Document in each participant's electronic clinical record all diagnostic assessments, individual plans of treatment, and treatment notes regarding recommended services and appropriate treatment.
• Maintain and adhere to ethics of confidentiality. Discuss confidential matters in an appropriate manner in compliance with the Health Insurance Portability Accountability Act (HIPAA).
• Independently complete commitments and take responsibility for actions; recognize and fix errors and omissions.
• Assume remote on call responsibilities on a rotating basis as per facility guidelines, as assigned.
• While this job description covers many aspects of the role, employees may be required to perform other duties as assigned.
   

Education & Experience

• Successful completion of an accredited Associate or Bachelor's Degree Nursing Program required. 
• Minimum 2 years of experience as a Registered Nurse required.
   

SPECIAL REQUIREMENTS

• Active, unrestricted RN license in NYS required. 
• Unrestricted, valid NYS driver's license for minimum of 1 year with a clean driving record and minimum insurance coverage that meets agency standards. 
• Basic Life Support (BLS) training within 60 days of hire and recertification annually.
   

Knowledge, Skills & Abilities

In addition to demonstrating the Hillside Professional Competencies of Communicates Effectively, Personal Excellence, Cultural Competence, Builds and Leverages Relationships, and Optimizes Decision Making, the following occupational competencies must be demonstrated:

• Ability to recognize signs of current and emerging health needs of children/youth and address issues proactively and effectively communicate with children/youth and families to assure appropriate understanding of treatment, issues, and objectives
• Possess and maintain accurate knowledge of all regulatory and practice regulations and treatment protocols with special attention to HIPAA requirements
• Demonstrate the highest standards for ethical and professional conduct at all times and towards all youth and families
• Proficiency with computer-based applications in order to independently complete work and add/use data
• Demonstrate a thorough knowledge of services provided both by the Agency and by external service providers and maintain contacts as needed in order to efficiently access care for clients
• Demonstrate a commitment to quality using resources efficiently and with the greatest effectiveness
   

Physical Demands & Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work a variable scheduling including evenings and weekends
• The following physical demands are required:
  • Occasional sitting (up to 4 hours)
  • Occasional standing (up to 1 hour)
  • Occasional walking (up to 2.5 hours)
  • Occasional driving (up to 8 hours)
  • Continuous balancing (up to 8 hours)
  • Occasional balancing, bending, stooping, climbing, kneeling, pushing, pulling, reaching forward or down, reaching overhead, running, and twisting (up to 2.5 hours)
  • Weekly lifting up to 50 lbs. (community-based staff may be required to lift an empty wheelchair weighing up to 50 lbs.), 10-15 lbs. on a daily basis
  • Weekly carrying up to 55 lbs. approximately 10-100 ft., 10-15 lbs. on a daily basis
• Manual dexterity is required, including the frequent ability to grasp in both hands and continuous use of fine manipulation skills in both hands (approximately 1-2.5 hrs.)
• Occasional exposure to dust, fumes, gases or chemicals is apparent. 
• Protective clothing or equipment as required: Close toed shoes; Protective Shields, Universal Precaution PPE, Gloves for toileting and food preparation
• Ability to change positions as needed

$75,000 Minimum pay rate, $90,000 Maximum pay rate, based on experience.

At Hillside, we believe that healthy youth and strong families with opportunities to succeed are the foundation of any thriving community. Guided by this belief, we provide community-based services, education, and residential treatment to positively impact lives, in partnership with youth and families who have experienced trauma. From locations across Central & Western New York and Prince George's County, Maryland, our programs serve nearly 10,000 youth, adults, and families each year.

Partnering with families and communities, we deliver high-quality, evidence-based services, in the appropriate settings - whether on residential campuses or in schools, homes, or the workplace. By measuring the impact of our work, we endeavor to deliver ever better outcomes every day.

Equal Opportunity Employer: Hillside is committed to equal opportunities for all, supporting a diverse workforce, creating development opportunities for our people. Hillside is an equal opportunity employer; individuals from underrepresented and/or marginalized identities, Veterans, and disabled persons are encouraged to apply. Upon request, reasonable accommodations will be provided for the disabled.

Total Rewards: We offer a competitive benefits package to include generous paid time off, paid holidays, comprehensive medical, dental and vision coverage, flexible spending account, 403(b) retirement savings plan with employer match, and Employee Assistance Plan - just to name a few of the amazing benefits at Hillside! World changers and change makers join our talent community every day. Apply online, get on board, and grow your career with us!