Clinical Review Assistant


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Job Number 51390
Posted 12/4/2017
Account Beacon Health
Department Population Health
Location Brewer - Wilson Street, ME 04412
Schedule Regular Full-time
Shift Day
Hours 7:00-3:30-Located at Inland Hospital
Job Details This Position is located at Inland Hospital



JOB SUMMARY:
The Clinical Review Assistant assists the regional manager and the nurse care coordinators in providing non-RN daily duties and tasks. These include but are not limited to clinical review of patients through the use of the EMR and claim reports. The role provides patient care within the scope of the licensure/certification. The role manages claim reports, EMR audits and special projects as assigned. The role requires a strong knowledge of computers and computer software.

Primary Respnisiblities
•Collects, reviews and documents patient's current health status and history according to standard/policy.
•Is knowledgeable in identifying patients in need of further follow up and refers to the appropriate clinician as indicated. Documents all aspects of the patient management according to hospital and practice standards/policies.
•Understands appropriate interventions that are provided in the clinical setting to include all aspects of the clinical management of the patient.
•Assists Care Coordination by researching patient information as assigned.
•Reviews and manages claims reports and other incoming patient information for the purpose of making care coordination referrals and providing patient care within the role and scope of the position.
•Completes auditing reports and queries to ensure the closure of gaps and for the identification of opportunities for improvement.
•Performs ongoing patient screening, and planning through effective collaboration the appropriate clinician.
•Provides telephonic follow-up management of patient per protocol/policy to include but not limited to visits scheduled at time of discharge and Patient/Family notification of next appointment as assigned.
•Organizes and distributes paperwork to all Care Coordination staff in an effective and timely manner.
•Assists with clerical duties as assigned i.e. report management, data reports, education material. Completes all documentation per standards/policy.
•Provides support for activities related to Care Coordination to facilitate on-going communications and efficient departmental operations.
•Coordinates patient educational materials and ensures their availability.
•Provides and distributes all appropriate patient education as directed.
•Documents patient interaction per standard/policy.
•Performs all assigned duties as directed by supervisor.
•Coordinates patient education material and follow up as directed.
•Ensures duties are adequately performed as needed or seeks out supervisor for guidelines.
•Maintains certification and BLS certifications.
•Demonstrates correct technique in the use of equipment, according to specific product information and policy and procedure manuals.
•Follows appropriate procedure for obtaining and returning/cleansing/disposing of equipment and supplies.
•Accurately researches and compiles assigned statistical data for department in a timely manner. Monthly statistics are completed within the assigned time frame.
•Develops and maintains a process to keep staff informed about necessary patient care information.
•Maintains appropriate departmental records, coordinates mail distribution and establishes departmental filing system to ensure the expeditious retrieval of information so that staff can accomplish their responsibilities.
•Adheres to established organization policies and procedures to include but not limited to HIPAA regulations, Code of Conduct etc., as per EMHS IDD/PCD policies and Beacon Health policies.
•Demonstrates the ability to develop and build strong computer skills in a variety of software products to include but not limited to EMR documentation and functionality, Microsoft products to include Visio, other products used to support Beacon Health.
•100% documented evidence of attendance of staff/department meetings, and/or reading/initializing the minutes, all other memos and postings.

EDUCATION AND/OR EXPERIENCE:
Two years' experience in community based outreach or demonstrated progressive advancement in responsibilities in healthcare setting such as clinic, hospital, etc.

Graduate of a two-year allied health program preferred.

CMA required (AAMA certification preferred) or Licensed Practical Nurse (LPN).

The successful candidate will also possess no less than 2 years' experience working in a fast paced office environment, including responsibility for accurate data entry, efficient management of high volume phone inquiries, and independent problem solving using pre-established guidelines.


Clinical Duties

1. Support and educate patients in areas including but not limited to: medication management and adherence; exercise; nutrition; health care system navigation. (Within the scope of certification/licensure)

2. Provide support and notifies clinical team and manager regarding changes in: Behavior, nutrition, exercise, substance use, medication compliance, and other issues as related to the established care plans. (Within the scope of certification/licensure).

3. Assist patients and coordinate with the care coordinators and the clinics regarding patient needs such as transportation, arrangements of appointments, medications, etc.

4. Complete all required documentation for regulatory standards.

5. Assure patients get appropriate and timely services by working with the care coordinator and the patient's provider office, by making referral requests as needed and by motivating/teaching people to seek care at the appropriate location and level of care.

6. Bridge community, cultural, linguistic and educational barriers to encourage patient self-care and participation in the management of their care.

7. Participate in regularly scheduled staff development trainings to maintain and improve personal knowledge base of various chronic diseases.

8. Participate and attend regularly scheduled staff meetings and other assigned meetings.

9. Communicate all concerns to clinical team and manager as necessary, seeking support and guidance proactively.

10. Complete all required documentation inclusive of electronic documentation, in a timely fashion in accordance with regulations and office standards.

11. Work performed is done in conjuncture with the patient's provider and the care coordinator to complement the office-based clinician's workflow.

12. Assumes and completes all other duties as assigned by regional manager or designee.


SKILLS AND ABILILITIES:
Demonstrates excellent communication skills.

Demonstrates the ability to perform multiple tasks simultaneously.

Ability to motivate others.

Ability to work with people from diverse backgrounds and experiences.

Ability to openly address and acknowledge observed issues and concerns.

Must pass background check.

Demonstrates proficiency in computer skills, including accurate keyboard entry of data into relevant computer based databases and spreadsheets and knowledge of a variety of software products to include Microsoft products.

Demonstrates proficiency with Microsoft Word, Excel and PowerPoint.

Demonstrates the ability to utilize various computer software products.

Attention to detail, and ability to be flexible in performing a variety of tasks.

Demonstrated ability to complete projects within designated timelines and the ability to prioritize duties as required.

Demonstrates ability to use basic office equipment, computer, fax machine, copier, calculator, etc.

EDUCATION AND/OR EXPERIENCE:
Two years' experience in community based outreach or demonstrated progressive advancement in responsibilities in healthcare setting such as clinic, hospital, etc.

Graduate of a two-year allied health program preferred.

CMA required (AAMA certification preferred) or Licensed Practical Nurse (LPN).

The successful candidate will also possess no less than 2 years' experience working in a fast paced office environment, including responsibility for accurate data entry, efficient management of high volume phone inquiries, and independent problem solving using pre-established guidelines.


The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.


Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.
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