Prior Authorization Utilization Review Jobs in Rochester, NY

Description

The LPN will work as a member of the Clinical Care Team, assisting medical providers in direct patient care and maintaining processes that result in efficient, high quality nursing and medical care.

Job Responsibilities:

• Maintains patient flow by preparing patients for their visits with providers. Assists Providers in responding to patient needs related to medications, lab results, procedures, preventative/health maintenance measures.
• Perform pre-visit planning: Utilize software tools (eg Azara) and chart review to anticipate health maintenance, preventive and chronic care needs of each day's scheduled patients and assess where acute visits may be accommodated; Huddles as needed with providers, care managers and other care team members (Patient Engagement, PSRs).
• Room/Prepare patients for provider visit:height/weight, vitals, med reconciliation, verify allergies, social history/smoking status, verify pharmacy, prepare refills; Follow health maintenance and chronic care protocols and enter as appropriate into chart/alert provider/provide to patient (eg mammogram req, colonoscopy referrals, FIT test kits); Set up room/prepare patient as appropriate for procedures/examinations; chaperone visit as needed; prepare consent forms, screening forms, smartforms, paperwork as needed.
• Performs in-house labs (lead, cholesterol, strep tests, urine, pregnancy tests, hemoglobin a1c) and procedures (eg EKG, peak flow meter) in accordance with standard nursing practice and/or health maintenance/chronic care protocols.
• Prepare lab specimens to be sent to the lab (DrugScan, biopsy, PAP, etc.)
• Provide age and patient appropriate screenings (eg Hearing/vision screening, PAM/Patient Activation Measure) and document/report as appropriate.
• Medication refill requests: review medlist/chart/dosing, check I-STOP (Prescription Monitoring System), load into EHR field for provider.
• Administer vaccines, injections, PPDs in accordance with standard nursing protocols and document appropriately (including NYSIIS).
• Answer and document phone calls from patients, pharmacies, etc.in accordance with HIPAA regulations.
• Provide nurse visits for patients: eg, blood pressure checks, allergy injections, vaccines and correctly and consistently reassign nurse visits to that day's appropriate on site provider.
• Clean exam rooms between each patient and as necessary.
• Stock exam rooms consistently and appropriately to maintain efficiency, quality and safety for patients and staff.
• Preload new patient clinical chart information/history: Immunizations, Medications, Problem Lists, Past Medical/Social/Family history.
• Complete paperwork as needed for Providers/patients.
• Initiates and completes all parts of medication prior-authorization requests based on insurance requirements.
• Perform family medicine/pediatric ED recalls.
• Perform machine/POCT controls in accordance with manufacturer recommendations/industry standards.
• Accept deliveries/orders and put supplies away.
• Document refrigerator/freezer temps twice a day.
• Check expiration dates: injections, medications, samples, instruments and supplies.
• Sanitize instruments after using.
• Monthly job duties (specific to each nurse).
• Maintain accurate and pertinent documentation in EHR according to guidelines in "Documentation of the Patient Record".
• Adhere to center infection control policies.
• Keep work area neat and tidy.
• Actively participate in QAPI activities.
• Participate in monthly nursing staff meetings and any other staff meetings within the organization.
• Maintain current Relias training.
• Adhere to all Oak Orchard policies and procedures.
• Any other reasonable requests from management.

Requirements

Skills / Qualifications:

• Ability to work with a diverse patient population
• Experience with EMR systems
• Excellent attention to detail
• Ability to communicate both written and verbally

Required Education and Experience:

• Graduate of an accredited program for Licensed Practical Nurse with a current valid license to practice nursing in New York State.
• One year of experience in a nursing role preferred.

Comprehensive Benefits:

Health / Dental /Vision Insurance

Retirement Plan

Tuition Reimbursement

Public Service Loan Forgiveness

Generous Time Off