Responsible for medical triage of members using established protocols, note taking via online ANS (Advice Note System) and providing specified diagnostic results to members. Responsible to collaborate with on-site physicians, on-call physicians, HCT, pharmacists, and/or Nurse Practitioner as necessary to facilitate member care. Essential Responsibilities:
Receives and processes telephone calls from Health Plan members requiring medical advice or general information by: Assesses the patients problem utilizing established protocols and interaction with provider on-site or on-call; makes appropriate recommendations to include advice, appointments per protocol, or direction from physician; appropriately documents calls received with adherence to inter-regional documentation; acts as an extension of the health care team to meet member needs.
Assists members in empathetic, efficient manner to determine best course of action to resolve issue.
Meets regional standards set by call center management to achieve optimal member satisfaction such as phone access and service standards. Be receptive to constructive feedback by supervisors and/or QI to better serve members.
Contributes to the development of protocols, procedures, patient education, and training, as assigned. Participates in peer review, quality assurance, and other committees functions.
Demonstrates ability to make quick decisions, based on sound base of critical thinking skills/guidelines by protocols.
Demonstrate ability to interact with a variety of levels of staff to provide good customer service to internal customers.
Performs other related duties as directed.
Basic Qualifications:
Experience
One (1) year of current experience as a RN in a clinical setting with relevancy required.
Education
N/A
License, Certification, Registration
This job requires credentials from multiple states. Credentials from the primary work state are required before hire. Additional Credentials from the secondary work state(s) are required post hire.
Registered Nurse License (Maryland) within 6 months of hire AND Registered Nurse License (Virginia) within 6 months of hire
OR
Compact License: Registered Nurse within 6 months of hire
Registered Nurse License (District of Columbia) within 6 months of hire
Additional Requirements:
Ability to type 30 WPM required.
Proficiency in the use of applicable computer software required.
Pass basic Windows test at interview.
Pass basic typing test required.
Must have effective interpersonal and communications skills.
In order to work effectively with patients, must have effective interpersonal and communications skills and be able to stand, walk, bend, lift at least 50 pounds, hear, speak, and see.