Job Summary: VA Clinical Contact Center Staff -Nurse is a registered nurse (RN) with collegiate preparation from an accredited nursing program. The Nurse is responsible for providing triage, referrals, and patient care recommendations in a call center setting during off hours on weekends, holidays, evenings, and nights (WHEN) hours. The incumbent demonstrates expertise in clinical triage utilizing approved algorithm software.
Essential Job Duties:
• Utilizes sound clinical judgment in assessing, planning, implementing, documenting, and evaluating a full range of nursing care to patients with complex care needs over the telephone, assuming responsibility and accountability for nursing actions.
• Utilizes effective communication and customer service skills to triage symptom-based concerns.
• Evaluates the veteran, develops a working nursing diagnosis, formulates a plan, and provides recommended intervention, during the call utilizing approved algorithm software.
• Assesses, develops, and implements a plan to meet the patient's learning needs, including self-care and treatment measures.
• Completes initial assessments and reassessments of patients' condition and response to treatment and other clinical findings and initiates follow-up with the appropriate VA Medical Center.
• Provides clinical advice in accordance with the approved algorithm software, directs the veteran for care based on their symptoms, past medical history, and level of urgency while employing critical thinking skills and knowledge-based nursing judgment.
• Identifies potential problems involving resources and/or safety and taking action to avert or manage the situation.
• Utilizes telephone systems and computer applications. Performs Quality Management activities such as identifying problem areas and analyzing findings for change.
• Perform other duties as assigned by management.
• Work Schedule: Evenings and Nights shifts, alternating coverage including weekend, holidays, and day shifts.
Education and Experience Requirements:
• BSN and experience in ICU, ED, and/or Telephone Triage is preferred.
• Must be proficient in spoken and written English.
• Licensure: Current, full, active, and unrestricted registration as a professional nurse. in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or the District of Columbia.
Additional Requirements as per contract/client:
• Position contingent on passing the VA security clearance
• United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
This position requires visual acuity, keen hearing, clear distinctive speech, and manual dexterity. This position requires potentially long periods of continued, standing and sitting. The incumbent must be a mature, flexible individual capable of working effectively in stressful situations, able to shift priorities based on patient needs.
As a federal contractor, Maximus is subject to Executive Order 14042 and the Safe Workforce Task Force’s COVID-19 Workplace Safety Guidance for Federal Contractors and Subcontractors. In light of these requirements, all employees will eventually need to be fully vaccinated as a condition of employment and new hires/employees will be required to provide proof of vaccination. Maximus will provide accommodations to individuals with qualifying medical conditions or sincerely held religious beliefs, practices or observances that preclude vaccination, provided such accommodations are reasonable, do not create an undue hardship for the Company, and/or do not pose a direct threat to the health and safety of you or others in the workplace. Approval of such accommodation is a condition of employment. New hires must provide proof of vaccination or have an approved accommodation request prior to their orientation date.
Essential Duties and Responsibilities:
- Audit medical records to ensure compliance with the Medicare Advantage Risk Adjustment standards including abstraction and assignment of appropriate codes based on clinical data.
- Enter coded data into a system accurately and validate date entered.
- Research correct coding practices, clearly document and share findings with others.
- Write clear and concise rationales that provide defensible support of decisions.
- Train staff members on the coding processes (both project specific and general coding).
- Perform QA audits on coding process.
- Recommend and suggest improvements to assigned projects.
- Perform other duties as assigned by management.
- High school diploma or equivalent with 4+ years of experience, or AA with 2+ years of experience.
- Preferred risk adjustment auditing experience of coding inpatient and outpatient medical records.
- CPC, CCS, or RHIT Certification required.
- Ability to use critical thinking skills.
- Must have excellent writing skills.