Patient Support Services Nurse

2 weeks ago

Saint Louis, United States Affinia Healthcare Full time
Job DescriptionJob Description

POSITION SUMMARY: Routinely measures and analyzes quality indicators in conjunction with Managed Care Patient Navigators for quality improvement. Utilizes sound nursing judgment, clinical preparation, knowledge, skills, and experience place, receive and route a high volume of calls escalated from Patient Support Services Call Center. Assists with additional reporting and auditing as required to coordinate and monitor provision of medical services in a professional manner for each individual patient.

POSITION QUALIFICATION REQUIREMENTS

Education: Bachelor of Science Degree in Nursing or graduate of an accredited school of practical nursing.


Experience:

  1. Three years' experience in primary care, behavioral health, community health, or related field.
  2. One year experience in a customer service or call center environment (preferred).
  3. Three years' experience in case management (preferred).

Skills and Abilities which may be representative but not all inclusive of those commonly associated with this position:

  1. Good computer skills including the use of Microsoft Word, Excel, and Outlook.
  2. Solid experience using an electronic health record.
  3. Excellent oral and written communication skills.
  4. Detailed oriented and strong organization skills.
  5. Good analytical, critical thinking and problem-solving skills.
  6. Able to work on multiple tasks simultaneously.
  7. Knowledge of managed care insurance plans.
  8. Ability to work independently, as well as with a team.
  9. Ability to motivate and educate clients and staff.

Residency and Transportation Requirement: Must possess a valid driver's license and automobile with insurance coverage as required by the State of Missouri.


License(s)/Certification(s) Required:

  1. RN or LPN license, CPR to practice in the State of Missouri
  2. CPR Certification

FUNCTIONS OF THE JOB

Essential Functions

  1. Performs initial medical triage on patients via telephone from routed calls via Patient Support Representatives in the Call Center requesting assistance including but not limited to; requests for medication refills, requests for advice related to an acute medical or dental health issue, requests to speak someone concerning a complaint or concern, medical records or directly with a nurse or PCP.
  2. Ability to determine the acuity of the caller's request and route in the appropriate manner per department protocol and/or determine necessity of next day or same day appointment needs.
  3. Demonstrates critical thinking skills to achieve outcomes and solve problems.
  4. Monitor a caseload of managed care patients for compliance with prescriptions, immunizations, appointments, education and health/dental care utilization.
  5. Performs medication authorization and refills. Contact patients for missed refills (asthma medications, prenatal medications, etc.). Document in appropriate plan portal.
  6. Communicate noncompliance to members of the health care and dental team for appropriate intervention.
  7. Assist with St Louis City Uninsured Sexually Transmitted Disease reporting, USCRI reporting and other tracking/audits deemed necessary.
  8. Delivers organized care by prioritizing care needs and tasks effectively. Adapts care to changes in patient's condition.
  9. Communicates with patients, team members, in an accurate, timely, and professional manner.
  10. Provides health education and counsel patients and family members in medication treatment and managed care case management.
  11. Collaborates with multidisciplinary team to further identify and resolve any barriers to timely care gap closures and reporting any concerns for interventions.
  12. Utilizes evidenced based practices to solve problems.
  13. Maintains the integrity of patient medical records, completes appropriate forms and reports accurately, and adheres to patient confidentiality.
  14. Performs other duties as assigned.

Marginal Functions:

  1. Participate in evaluating and planning for existing and new services.
  2. Assist providers in completing all medical documentation needed to close care gaps.
  3. Serves as liaison between various Affinia Healthcare initiatives, the Patient Services Teams and the community.
  4. Attends group team meetings other agency meetings as required.
  5. Perform internal and external audits of records to maintain quality and compliance standards.

Supervises: None


NOTE: Affinia Healthcare is a Covid-19 Vaccine Mandated Employer. All employees of Affinia Healthcare are required to be vaccinated for Covid-19.

NOTE: SMOKING IS PROHIBITED IN THE WORK ENVIRONMENT

NOTE: ALL APPLICANTS MUST PROVIDE CONTACT INFORMATION FOR THREE REFERENCES

AN EQUAL OPPORTUNITY SERVICES PROVIDED ON A NON-DISCRIMINATORY BASIS

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