RN Tele-Health Triage - Kelsey-Seybold Clinic - Remote

UnitedHealth Group•Pearland, TX

6d•$29 - $52•Remote

About The Position

The RN Tele-Health Triage is a registered nurse who is responsible for incoming calls and transferred calls from patients, physicians, and healthcare organizations. Using nursing knowledge and departmental protocols, the Primary Care at Home Desk RN will assess the patient and will follow triage guidelines and protocols to offer appropriate options for care. The RN will escalate concerns/high acuity cases according to guidelines to Primary Care at Home providers and medical director. The Primary Care at Home Desk RN will document appropriately in EPIC to ensure accurate departmental record keeping. The Primary Care at Home Desk RN will facilitate referrals to primary care providers, specialists, healthcare facilities, community resources, and facilities. Supports benefit verification and prior authorizations for health care services/procedures that require authorization per payor/plan requirements. Collects pertinent information needed for medical review from referring provider to ensure service decisions are determined within appropriate timeframes. The Primary Care at Home Desk RN will own and modify triage and authorization workflows and will educate staff about triage and authorization processes. The Primary Care at Home Desk RN will be flexible and adapt to changes in policy and procedures, new techniques, and additional responsibilities as assigned to meet changing business needs. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements

Associates of Science in Nursing
RN from an approved school of nursing with current license to practice professional nursing in the State of Texas
5+ years of total progressive clinical RN experience for adult and/or pediatric patients
2+ years of experience with capitated payment arrangements
1+ years of experience specifically working with insurance (HMO, PPO, and POS) companies to obtain authorizations and precertification for medical services
Experience with EMRs and medical records
Familiarity and application of CPT, ICD, and HCPS codes
Basic PC skills including Windows Operating System
Typing skills of 30 WPM
Proven excellent communication skills
Proven ability to multi-task and prioritize responsibilities
Ability to travel throughout the greater Houston area to facilities and patient homes.
Must have reliable transportation and current insurance coverage

Nice To Haves

Bachelor of Science in Nursing
Certified Coder
2+ years in ambulatory/primary care setting.
Experience with EPIC EMR

Responsibilities

Responsible for incoming calls and transferred calls from patients, physicians, and healthcare organizations.
Assess the patient using nursing knowledge and departmental protocols.
Follow triage guidelines and protocols to offer appropriate options for care.
Escalate concerns/high acuity cases according to guidelines to Primary Care at Home providers and medical director.
Document appropriately in EPIC to ensure accurate departmental record keeping.
Facilitate referrals to primary care providers, specialists, healthcare facilities, community resources, and facilities.
Support benefit verification and prior authorizations for health care services/procedures that require authorization per payor/plan requirements.
Collect pertinent information needed for medical review from referring provider to ensure service decisions are determined within appropriate timeframes.
Own and modify triage and authorization workflows.
Educate staff about triage and authorization processes.
Be flexible and adapt to changes in policy and procedures, new techniques, and additional responsibilities as assigned to meet changing business needs.