Registered Nurse Case Manager - Medication Prior Auth

SouthEast Alaska Regional Health Consortium•Renton, WA

2d•$39 - $55

About The Position

We are looking for a RN in the state of Alaska, or near Renton, WA. This position functions within the nursing department and is responsible for coordinating the delivery of appropriate and timely care for patients, promoting quality, and cost-effective health care outcomes. SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement. Working at SEARHC is more than a job, it’s a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health insurance, dental, and vision benefits, life insurance and long and short-term disability, and more. We are looking specifically for a RN in the state of Alaska, or near Renton, WA Key Essential Functions and Accountabilities of the Job Active management of SEARHC patients. Collaborates with medical providers and interdisciplinary team members to establish individualized medical goals that maximize patient healthcare outcomes. Coordinates multi-disciplinary care conferences for high-risk or complex patients referred into the case management process. Manages panel acute and chronic care needs as well as health maintenance, by continuously reviewing EHR reminders and triggers and providing outreach and education to patients. Participates in case management reviews for high-need patients with a multi-disciplinary team. Advocates for patient/client family at the service-delivery level, fostering decision making, independence, self-care, and growth. Uses problem-solving and anticipatory skills to meet patient and provider needs in a prompt, efficient manner. Facilitates coordination of patient referrals within SEARHC and outside facilities. Tracks progress and outcomes, providing periodic status reports to providers. Serves as the primary link for other case managers and discharge coordinators in care coordination. Proactively identifies delays and obstacles to care and works to remedy individual cases and improve processes. Performs staff nursing duties in various clinic roles, including assessment, documentation, education, and administering medications/therapies. Maintains annual competencies including safety and infection control requirements. Promotes effective nursing staff relationships and maintains a clean, safe working environment. Adheres to infection control policy and procedures. Communications and Teamwork Builds bridges and creates rapport with team members within departments and across the organization. Participates in department and clinic team improvement efforts. Active member and leader among the clinical team, nursing staff, and unit coordinators. Participates in continued development of the case management role in primary care. Participates in triage and responds to emergency situations. Performs other duties as assigned, including special projects to provide comprehensive health services. Additional Focus Areas Specialty Clinic Facilitates coordination of specialty clinic referrals. Manages referrals and waitlists. Reviews referrals for appropriateness and completion of work-up labs/diagnostics. Consults with referring providers for questions or concerns. Schedules patients in requested clinics based on priority. Ensures pre-appointment diagnostics are ordered, scheduled, and completed. Coordinates with other facilities for clinic availability. Tracks progress and outcomes of referrals, providing periodic status reports. Ensures referral records are received and available for provider review. Provides clinical support for all specialty clinics, including assessment, documentation, education, and administering medications/therapies. Prepares clinical space and assists providers during medical procedures. Assists medical staff with educational in-services provided by specialty clinic providers. Prior Authorization Coordinates and manages the prior authorization process for patient referrals, procedures, medications, and treatments. Reviews clinical documentation to ensure all necessary information is included for authorization requests. Communicates with providers, payers, and patients to facilitate timely approvals and resolve issues or denials. Tracks the status of prior authorization requests and provides updates to providers and patients. Maintains accurate records of all prior authorization activities and ensures compliance with organizational and payer requirements. OB Case Management Primary case manager for OB patients. Responsible for intake and tracking processes, education, and outreach for OB patients. Works closely with primary care providers and case managers to ensure comprehensive care. Tracks postpartum care and newborn immunizations. Video Teleconferencing (VTC) Communicates and coordinates all video teleconferencing visits with specialty providers from AK Native Medical Center. Acts as nursing staff for those visits.

Requirements

Graduate of an accredited school of nursing
Current full, unrestricted Registered Nursing license in Alaska or other U.S. state required.
Direct Hire must have applied for an Alaska nursing license before start date. Agency staff must have an active Alaska license.
Basic Life Support certification preferred.
National Case Management certification preferred.
High school diploma or equivalent required.
Clinical Competency required within 3 months of hire and every three years
At least 1 year of general nursing experience with at least 6 months’ employment as a clinical nurse at a SEARHC outpatient clinic OR at least 2 years of general nursing experience with a minimum of 1 year in an ambulatory setting or 1 year case management experience.
Knowledge of SEARHC services and those of other tribal health organizations in Alaska
The nursing process and the ability to apply this knowledge in the working environment.
Customer service principles.
Safety and infection control principles.
Skills in Assessment, anticipation of needs, and data collection.
The use of equipment such as computers and medical equipment.
Oral and written communications.
Ability to Multi-task and work independently in fast paced environment.
Maintain compliance with annual competencies.
Problem-solve and use conflict resolution skills to develop and maintain good working relations with other staff and departments.
Anticipate needs of others and to seek help when appropriate.
Ability to work within a very fast paced clinical setting.
Move at a quick pace, stand for long periods of time, bend, stoop, climb and move to the floor.
Follow simple and complex directions and perform multiple tasks at once.
Perform job using theory-based nursing practice model, evidence-based practices, and shared governance in a multi-disciplinary setting.
Clinical Competency Assessment - SEARHC
Registered Nurse License - State of Alaska - Alaska State Board of Nursing

Nice To Haves

Bachelor’s degree preferred.

Responsibilities

Active management of SEARHC patients.
Collaborates with medical providers and interdisciplinary team members to establish individualized medical goals that maximize patient healthcare outcomes.
Coordinates multi-disciplinary care conferences for high-risk or complex patients referred into the case management process.
Manages panel acute and chronic care needs as well as health maintenance, by continuously reviewing EHR reminders and triggers and providing outreach and education to patients.
Participates in case management reviews for high-need patients with a multi-disciplinary team.
Advocates for patient/client family at the service-delivery level, fostering decision making, independence, self-care, and growth.
Uses problem-solving and anticipatory skills to meet patient and provider needs in a prompt, efficient manner.
Facilitates coordination of patient referrals within SEARHC and outside facilities.
Tracks progress and outcomes, providing periodic status reports to providers.
Serves as the primary link for other case managers and discharge coordinators in care coordination.
Proactively identifies delays and obstacles to care and works to remedy individual cases and improve processes.
Performs staff nursing duties in various clinic roles, including assessment, documentation, education, and administering medications/therapies.
Maintains annual competencies including safety and infection control requirements.
Promotes effective nursing staff relationships and maintains a clean, safe working environment.
Adheres to infection control policy and procedures.
Builds bridges and creates rapport with team members within departments and across the organization.
Participates in department and clinic team improvement efforts.
Active member and leader among the clinical team, nursing staff, and unit coordinators.
Participates in continued development of the case management role in primary care.
Participates in triage and responds to emergency situations.
Performs other duties as assigned, including special projects to provide comprehensive health services.
Facilitates coordination of specialty clinic referrals.
Manages referrals and waitlists.
Reviews referrals for appropriateness and completion of work-up labs/diagnostics.
Consults with referring providers for questions or concerns.
Schedules patients in requested clinics based on priority.
Ensures pre-appointment diagnostics are ordered, scheduled, and completed.
Coordinates with other facilities for clinic availability.
Tracks progress and outcomes of referrals, providing periodic status reports.
Ensures referral records are received and available for provider review.
Provides clinical support for all specialty clinics, including assessment, documentation, education, and administering medications/therapies.
Prepares clinical space and assists providers during medical procedures.
Assists medical staff with educational in-services provided by specialty clinic providers.
Coordinates and manages the prior authorization process for patient referrals, procedures, medications, and treatments.
Reviews clinical documentation to ensure all necessary information is included for authorization requests.
Communicates with providers, payers, and patients to facilitate timely approvals and resolve issues or denials.
Tracks the status of prior authorization requests and provides updates to providers and patients.
Maintains accurate records of all prior authorization activities and ensures compliance with organizational and payer requirements.
Primary case manager for OB patients.
Responsible for intake and tracking processes, education, and outreach for OB patients.
Works closely with primary care providers and case managers to ensure comprehensive care.
Tracks postpartum care and newborn immunizations.
Communicates and coordinates all video teleconferencing visits with specialty providers from AK Native Medical Center.
Acts as nursing staff for those visits.