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This role works effectively with all levels of the organization and the medical community to coordinate services that improve quality and efficiency of patient care and monitor outcomes. The Clinical Administrative Nurse Consultant RN will help to assist clinical departments to provide safe, efficient, and evidence-based care. This role will be a resource for education, process improvement and adherence to organizational policies.
Supervision Received: Director of Patient & Clinical Support
Supervision Exercised: None
Primary Responsibilities:
- Assists with patient care needs and suggests solutions to patient care crisis problems. Participates in the case review process to resolve concerns regarding patient care, patient complaints, appeals and peer review.
- Clinical support and documentation of critical issues, e.g., communicable disease response, sterilization process and documentation, vaccine storage and management and clinic emergency bags.
- Assist Quality and Safety staff in problem solving and follow-up education needs. Participate in quality improvement activities as appropriate; identify problems and offer suggestions for improvement.
- Clinical Interface/Liaison (clinical problem solver with facilities, providers, carriers; resolution of issues concerning members, benefit interpretation, program definition and clarification).
- Clinical Operations Analysis (monitors and analyzes medical management activities; provides analytical support to clinical programs; may perform clinical assessments and clinical audits).
- Clinical Training (planning, coordinating, delivering and evaluating clinical training).
- Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services).
- Clinical Program Management (development, implementation and/or on-going management and administration of a clinical program(s). Provides strategic oversight and support, measurement standards and revisions as needed for delivery of programs).
- Serves as a role model for others through compliance with Optum Oregon policies, OSHA, and state/federal labor laws. Assists in the development and maintenance of regulatory initiatives, e.g., Accountable Care Act programs and requirements.
- Develops clinical policies and standards and ensures ongoing review of existing policies.
- Plans initial training and continuing education of clinical staff. Develops education and training for organizational program initiatives. Trains back office leads on their role as preceptors for the clinical staff and other clinical responsibilities. Plans and executes monthly Back Office Leadership meetings.
- Serves as a medico-legal resource to the organization. Documents all inquiries for medico-legal/statistical purposes.
- Participates in professional development activities to keep current with health care trends and practices.
- Maintains strictest confidentiality.
- Performs other duties as assigned.
Required Qualifications:
- Graduate from an accredited school of nursing.
- Current Oregon Registered Nurse license.
- Current healthcare level BLS/CPR certification.
- 5+ years of professional nursing experience in a clinical, home care, medical/surgical, or ambulatory setting.
- Knowledge of Nursing theory and practice to give and evaluate patient care.
- Knowledge of community resources.
- Knowledge of organization policies, regulations and procedures to administer patient care.
- Knowledge of common safety hazards and precautions to establish a safe work environment.
- Good computer and typing skills.
- Demonstrated basic counseling skills and a positive, enthusiastic, and helpful personality to provide excellent patient service.
- Demonstrated skill in identifying problems and recommending solutions.
- Demonstrated skill in preparing and maintaining records, writing reports, and responding to inquiries.
- Demonstrated skill in developing and maintaining quality assurance.
- Demonstrated skill in establishing and maintaining effective working relationships with patients, medical staff and the public.
- Proven ability to react calmly and effectively in emergency situations.
- Proven ability to identify relevant internal policies and regulatory guidelines; establish/follow compliance procedures and enforce regulations and guidelines.
- Proven ability to complete applicable documentation (e.g., draft letters of denial/approval, member/provider contacts) following relevant internal and external regulations and guidelines.
- Proven ability to follow departmental processes (e.g., workflows, job aids); write and/or enforce policies to minimize risk and meet external regulatory requirement.
- Current Oregon driver license in good standing and reliable & insured transportation.
Typical Physical Demands: Work may require sitting for long periods of time; also stooping, bending, and stretching. Occasionally requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Occasionally may lift and carry items weighing up to 25 pounds. Requires corrected vision and hearing to normal range. Requires working under stressful conditions.
Typical Working Conditions: Work is performed in an office environment. Involves regular telephone contact with clinical staff and providers regarding patient and clinical risk management issues. Work may be stressful at times.
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