Medical Review Nurse

2 months ago

Langhorne, United States Pyramid Healthcare Full time

Pyramid Healthcare Admission Staff are at the front lines of our Substance Abuse Treatment Facilities. They represent all employees and Company reputation as the first line of contact for most of our callers.

Pyramid Healthcare, Inc. has Inpatient Facilities in Pennsylvania, New Jersey, Maryland, North Carolina, and Virginia.

Pyramid Healthcare Admission Staff are at the front lines of our Substance Abuse Treatment Facilities. They represent all employees and Company reputation as the first line of contact for most of our callers.

Pyramid Healthcare, Inc. has Inpatient Facilities in Pennsylvania, New Jersey, Maryland, North Carolina, and Virginia.

Essential Functions:

Handle medical reviews for potential clients Availability to complete reviews during off hours, on an on-call basis Successfully work with other departments across the organization Conduct screening on potential client calls. Complete all documentation associated with client calls. Complete all required reports associated with Needs Assessment/Referral Development. Handle on-call/off hours’ admissions, referral, and transportation needs. Actively cultivate and manage relationships with staff Provide positive, cordial and appropriate front line interactions with client (patient, family member or healthcare professional) and provide excellent customer service in triaging phone calls, including those from voicemail to ensure efficient responses Advanced knowledge of business processes and procedures maintaining working knowledge of all required computer systems and department policies and procedures Ability to use discretion and independent judgment Initiative to work productively with minimal supervision Demonstrated flexibility and motivation to learn and grow in the position Supportive interpersonal skills to assess individuals need/purpose in calling; determine/differentiate if emergency/non-emergency situation to refer appropriately Primarily responsible for the registration/admission of Clients into PHC Facilities Respond promptly to inquiry calls Coordination with referral sources Conduct pre-admission assessments Review prospective admissions against approved admission criteria, policies and procedures Responsible for maintaining all the documentation involved with the admissions process Familiarity with Medical Assistance platforms in multiple states Coordination of transportation arrangements for Clients Communication with Facility Leadership/Staff as needed Refer inquiries to other agencies and community resources when not appropriate for facility admission.

Knowledge, Skills and Abilities :

Excellent oral and written communication skills Excellent organizational, time-management, and follow up question skills required Basic knowledge of third party health care requirements and practices preferred Analytical skills necessary to evaluate client needs Maintain a professional demeanor on the telephone Maintain confidentiality pertaining to Clients Possess excellent organizational and time management skills Must be able to work independently, as well as part of a team. Willingness and ability to work in a fast paced environment. Must be computer proficient (Electronic Client Record, Spreadsheets, Word Documents, Email) Adhere to all Company policies and procedures.

Education, Experience:

Current nursing license in state of practice. Knowledge of continuous improvement techniques. Awareness and understanding of regulating bodies (CARF, Office of Mental Health, DDAP).

Job-related Behavioral Characteristics:

Demonstrates professionalism, leadership, confidentiality, strong social communication skills, time-management, organized. Must possess skills to communicate effectively and interact well with people of diverse backgrounds. Excellent oral and written communication and interpersonal skills. Ability to problem solve by gathering and analyzing information, working well in an individual/ group problem solving situation, and showing initiative in problem solving. Maintains professionalism and does not show favoritism. Maintains consistency with clients, staff, visitors, and the public. Ability to handle a crisis situation and react appropriately. Flexibility and adaptable. Ability to make decisions in an objective and ethical manner. Calm and decisive in crisis situations. Ability to sustain a team environment, drive continuous improvement projects, confidentiality, excellent problem-solving skills and excellent communicator within the team framework.

Pyramid CORE Values:

We are committed and proud to live our CORE values and use them to inspire those around us. Our employees are expected to align with these values, behaviors and standards. We are held accountable for upholding these CORE Values: INTEGRITY is striving to be honest, transparent and ethical when dealing with clients, staff and the community. DEDICATION is demonstrating an unwavering commitment to always provide exceptional care and support to those we serve is needed daily. COLLABORATION is a steadfast, team-focused approach; working together to achieve excellence. PASSION is genuine, compelling and relentless desire to improve lives and support Pyramid Healthcare’s mission.

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