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Company: MedStar Medical Group
Location: Washington, DC
Career Level: Mid-Senior Level
Industries: Not specified
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Description

General Summary of Position

 

 

 

 

 

 

 

 

 

 

Provides comprehensive support for the project, with increasing knowledge and awareness of risk factors. This might include including identification of patients who are not in care, coordinating home visits as needed, facilitating community groups, conducting testing in various environments and coordinating data and reporting to the sponsor. Facilitates coordination of the medical plan of care using a medical case management model. Collaborates with community partners to build linkages to care and actively participates in city-wide initiatives.


Primary Duties and Responsibilities

  • Consistently demonstrates support for compliance in the performance of job duties and responsibilities by a) developing and maintaining knowledge of, and performing job functions in compliance with, rules, regulations, policies, and statutes that affect his/her job; b) maintaining knowledge of and performing job functions in compliance with MedStar Health and MedStar Health Research Institute policies and procedures; and c) reporting compliance concerns in an appropriate and timely manner.
  • Acts as a community liaison.
  • Assists in the identification of potential Case Management candidates through clinical review, selected diagnoses, etc. and makes appropriate referrals.
  • Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.
  • Initiates contact with providers to obtain clinical and prescribing information to facilitate care or pending of pre-certification requests and pharmacy management issues. Recommends use of appropriate in network/ formulary benefits.
  • Coordinates patient intake, ordering, receipt, and administration of medications.
  • Develops a standardized process/workflow for identifying patients and simplifying medication ordering through individual insurer collaboration for both public and private insurance carriers.
  • Interacts with assigned community populations of limited volume. Interaction is designed to improve patient access to care, and education regarding the disease and support services.
  • Maintains current knowledge of insurance benefits and enrollment issues in order to accurately coordinate services.
  • Maintains timely and accurate documentation in the EHR system per Case Management policy.
  • Tracks number of patients seen, noting pertinent information regarding treatment outcomes. Extrapolates data as needed to complete reports.
  • Participates in staff meetings, Care Management meetings, Pharmacy and Therapeutics Committee, work groups, etc. as assigned. Provides input, completes assignments, and shares new findings with staff.
  • Processes pre-authorizations for medical necessity, LOC, covered benefits, and participation of the provider.
  • Actively participates in Quality Improvement initiatives.
  • Assists in outpatient clinic as available, meeting with identified patients and developing a plan of treatment for adherence issues. Refers patients as needed for other services such as peer coordinator or mental health.
  • Attends weekly clinic rounds to identify patients in need of services.
  • Collaborates with the interdisciplinary team to achieve patient and program goals.
  • Conducts home visits with identified patients, coordinating telemedicine oversight with providers.
  • Coordinates all aspects of the project and serves as the primary contact for the sponsor.
  • Performs other duties as assigned.
    • CUSTOM.PRIMARY.DUTIES.RESPONSIBILITIES.ADDENDUM


     

    Minimum Qualifications
    Education

    • Graduate from an accredited School of Nursing required and
    • BSN preferred

    Experience

    • 3-4 years Diverse clinical experience required

    Licenses and Certifications

    • Current license as a Registered Nurse in the District of Columbia. required

    Knowledge, Skills, and Abilities

    • Basic math skills.
    • Verbal and written communication skills.
    • Basic computer skills.


    This position has a hiring range of $87,318 - $157,289

     


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