Registered Nurse - Nurse Navigator Depart - Work from Home

Group & Pension Adminstrators, Inc - Dallas, TX (30+ days ago)


Group & Pension Administrators, Inc. (GPA) is committed to providing the highest-quality, customized healthcare benefit solutions for self-funded employers and their members. What drives us? Very simply, we care.

We are looking to add to our already dynamic team! If you want to grow your career with one of the Best Places to Work, are competitive, energetic, have great people skills, and enjoy working with people, we want to meet you!

If you are considering this opportunity, you will have to possess the following skill set and have had experience with the following responsibilities:

The Registered Nurse Navigator is responsible for providing coordination of medical services and educational resources to members participating in the GPA Nurse Navigator Program by utilizing nursing education, clinical and professional experience. The Registered Nurse will practice within the scope of practice while performing assessments, coordination, planning, monitoring and evaluation.

Essential Functions:
Perform clinical assessment of members contacting the GPA Nurse Navigator program to identify and deliver indicated medical service coordination
Research options for indicated medical service coordination utilizing a variety of sources to identify provider options, patient reviews of indicated providers, quality indicators and cost of care
Utilize clinical knowledge, expertise and GPA approved educational resources to provide verbal and/or written educational resources to members regarding medical diagnosis, procedures and/or treatments
Complete Medical Necessity Utilization Reviews utilizing GPA approved clinical guidelines to perform medical necessity reviews
Facilitate appointment scheduling and medical record retrieval
Assess and review current treatment and history to identify appropriate member referrals to Care Management Programs
Assess post appointment and/or post procedure to evaluate for further required intervention
Perform out of network provider negotiation as indicated
Document member activity in established format in appropriate software programs in compliance with HealthWatch Policy and Procedures
Accurate documentation in appropriate software including timeslips in CaseTrakker Dynamo maintaining compliance with HealthWatch Policy and Procedures
Clinical consult to HealthWatch Physician Advisor as indicated
Participation in Quality Assurance review process as indicated
Facilitate completion of Patient Satisfaction Surveys
Communicate (in compliance with HIPAA) with brokers, vendors, Account Managers, HR representatives as indicate
Delegate appropriate support activities with appropriate oversight of delegated activities
Areas of Responsibility: Registered Nurse
In addition to performing standard duties, the Registered Nurse is involved in clinical decision making and patient education. The scope of practice for nursing work includes, but is not limited to:

Evaluating clinical data
Assessment and evaluation of the acquired clinical data to assess for appropriateness of treatment plan based upon GPA clinical guidelines
Coordination of treatment plans, interventions and outcomes measurement
Rationale for the effects of medication and treatments
Provide patient education and educational resources

Accurately report:
Administration of medication and treatments

Client response

Contact with other health care team members

Respect the client’s right to privacy by protecting confidential information
Promote and participate in education and counseling to a participant based on health needs
Clarify any treatment that is believed to be inaccurate, non- efficacious, or contraindicated by consulting with appropriate practitioner

Qualifications/Education:
Graduation from an Accredited School of Nursing
Active and unrestricted Registered Nurse License in eNLC compact state

Requirements

Experience in a clinical environment such as in a Hospital, Physician’s Office or related field
Good communication skills with personable and approachable demeanor
Maintain active Registered Nurse license and CEU’s as required by the State Board of Nursing
Team player who builds effective working relationships and handle multiple tasks & assignments
Proficient in typing and Office Software (Word, Excel, PowerPoint) and other programs such as Outlook, Internet Explorer and standard office equipment
Ability to work independently in a home office environment (when applicable)