RN CLINICAL REVIEWER / PATIENT EDUCATOR

Description

GENERAL DESCRIPTION OF POSITION:

Performs a variety of duties working collaboratively with all clinicians and administrative staff. Performs functions to enhance quality, address prevention, increase compliance, improve patient satisfaction, maximize efficiency of providers/nurses, and meet Accountable Care Organization (ACO), Primary Care Medical Home (PCMH), and Value Based Contracting (VBC) guidelines.  Implements and follows Su Clinica (SC) policies and procedures. As a member of the clinical team, total support of the Patient Centered Medical Home (PCMH) guidelines, policies, and procedures are necessary. Works with the multidisciplinary team in ensuring attestations are completed in a timely manner and provide both group and individual classes for DSME. This position may require you to float to other departments within SC besides your assigned primary location and/or to another SC location. Performs other duties as assigned.

ESSENTIAL JOB FUNCTIONS: (with or without accommodations)

• Consistently exhibits behavior and communication skills that demonstrate SC’s commitment to superior customer service, including quality, care and concern with each internal and external customer.
• Always adheres to safety policies and procedures and monitors patient safety.
• Anticipates the needs of the Primary Care Provider by researching and providing supporting documentation for attestations, completing clinical reviews of chart and documenting in the A & P.
• Performs complex nursing procedures within the scope of practice of an RN.
• Maintains clinical standards outlined in nursing clinical policies and procedures; identifies deficiencies and makes recommendations for change.
• Coordinates with clinicians and ancillary departments to plan daily work assignments according to teammate’s abilities, patient and clinician schedules, patient flow and procedures.
• Ensures that all equipment is maintained and in working order.
• May perform telephone screening.
• Always adhere to Standard Precautions.
• Collaborates with Clinic Manger with daily operations of department.
• Ensures compliance with the PCMH Guidelines
• Assists with Quality Metrics, telephone follow up procedures.
• Identifies and participates in quality improvement projects.
• Uses, protects, and discloses our patients’ protected health information only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Ensures referrals are made as appropriate.
• Ensures immunization records and updating electronic medical record (EMR) are current, uploads any supporting documentation for attestation to EMR.
• Monitors overdue orders and follows approved process to address the orders.
• Attends/participates in mandatory annual skills validation for self and staff and other clinical updates that may take place during evening hours and or weekends.
• Attends all Nursing Supervisor meetings unless other arrangements are made to be absent.
• Assists clinician and licensed nursing teammates in responding to patient emergency situations as per Emergency Response Protocols; Respond to Rapid response.
• Attend staff/clinician “huddles.”
• Cross training to work in other departments or other duties as assigned by supervisor /management.
• Conducts DSME classes for identified patients individually and in groups.
• Attend MCO meetings as indicated.
• Performs additional duties as assigned.

Manages Patient Information:

• Performs clinical reviews of patient medical records to complete attestation for MOC’s, ACO’s, and other entities as needed.
• Assures the patient information and records is completed timely and is current. Identifies and uploads supporting documentation.
• Adheres to all HIPAA regulations in and outside of the Clinic.
• Enforces the importance of patient confidentiality and HIPAA regulations by the nursing support staff.
• Communicates patient information as requested to enhance patient services. 

Team Communication:

• Ensure provider’s schedule is reviewed & attestations completed. Schedule is reviewed several times daily for any add on patient with attestation.
• Communicates specific population management information.

• Coordinates care with inter-disciplinary team and community partners.
• Helpful, respectful, and team oriented.
• Prepares medical and drug histories for patient records as needed for medication adherence if indicated.
• Participates in committees, projects, and Performance Improvement initiatives. 
• Attend clinic meetings and other staff meetings.
• Maintains regulatory standards and organizational systems.
• Works with multi-disciplinary team in maintaining agency policies, procedures, and philosophies.
• Completes Incident Reports, troubleshoot resolutions with team.
• Ensures that medical records for patients always follow facility or clinic policies, Federal and State Laws and Regulations and will review medical records to ensure compliance.
• Participates in quality assurance activities and compliance to operational standards, participates in program development, development or implementation of operating policy and procedures, and promotes continuous improvement of workplace safety and environmental practices, as requested.
• Provides weekly reports of charts prepped for attestation including patient name, medical record number, and provider.
• Attends any MCO training on documentation, attestations.
• Provides monthly reports of DSME and DPP classes to PI director.
• Performs other duties as assigned.

Demonstration of Safe and Professional Conduct:

• Maintains a friendly environment for self and others.
• Responds to emergency situations as per training and response to rapid response.
• Refrains from texting and speaking on the cell phone while on duty.
• Refrains from informal communication with patients and others
• Participates in the performance improvement and follows all the Clinic policies and procedures.
• Attends work on a regular and predictable schedule in accordance with Clinic leave policy and performs other duties as assigned.
• Responsible for their own safety as well as the safety of others
• Adheres to a professional appearance in dress and behavior/conduct.
• Attends SC educational programs, committee meetings or other meetings as required.
• Submits required documentation in a timely manner (credentialing requirements, license renewals, certifications, continuing nurse education attendance, etc.)
• Participate in committees, projects & performance improvement initiatives.   
• Ability to use different MCO portals.

POSITION DIRECTLY SUPERVISED: none.

Qualifications

KNOWLEDGE, SKILLS, AND ABILITIES: (use of equipment, job related knowledge, language, etc.)

• Knowledge of practice level procedures, techniques, and practice of patient care
• Knowledge of computer and computer software (EMR, Microsoft Word, Excel, etc.) programs as necessary and telephone system
• Knowledge of community resources
• Knowledge of SC policies and procedures
• Knowledge of Infection Control policies and procedures
• Knowledge of the Chronic Care Model and PCMH    
• Skilled in use of computer and computer software (EMR, Microsoft Word, Excel, etc.) programs as necessary
• Ability to complete basic/intermediate math computations and medical math conversions.
• Ability to examine documents for accuracy and completeness.
• Ability to maintain an effective and professional working relationship with the public and co-workers.
• Ability to maintain client, office confidentiality and abides by confidentiality expectations and HIPAA guidelines.
• Ability to prepare records in accordance with detailed instructions.
• Ability to work in a fast-paced environment.                                
• Able to bend, stretch, stoop, stand, sit, and lift 20 pounds.        
• Able to show excellent interpersonal skills reflecting clarity, diplomacy and communicate accurately and effectively with all levels of staff and management.
• Ability to communicate concerns to appropriate personnel using tact and diplomacy.

• Ability to fully comply with the enhanced infection control requirements of the clinic.
• Flexibility, adaptability and openness to feedback
• Ability to handle emergencies in the early morning on weekends/holidays.

MINIMUM QUALIFICATIONS/CERTIFICATES/LICENSES/REGISTRATIONS REQUIRED:  HS Diploma or GED. Current licensure as an RN in the State of Texas is required. Preferably two (2) years of clinical experience in a healthcare setting.  Must be current with BLS/CPR certified.  Experience in working with the public preferred.  Must be computer literate.  Bilingual (English/Spanish) a must. This position requires an initial N95 mask fit testing and annual test fitting thereafter unless there is a significant change during the year that requires retesting prior to the annual fit testing. Strong supervisory, organizational, and leadership skills. Ability to work with complex cases and vulnerable population.

SPECIAL INSTRUCTIONS: This position requires travel. Employee must provide transportation.  If employee operates a personal motor vehicle in the performance of their official duties, the employee must possess a current valid Texas driver’s license for the appropriate type of vehicle and Texas Liability insurance. This position requires that an employee’s driving record be verified with law enforcement to ensure compliance with SC’s driving policy.

Due to the nature of SC Services, it may be necessary for employees to work extended hours or other variations of the usual shift to ensure adequate care to patients and to maintain service to the community.