Job Closed
This listing is no longer active.
Headquartered in Bethlehem, Pennsylvania, St. Luke's University Health Network - SLUHN is a nationally recognized nonprofit network of health organizations, hos
Clinical Triage Specialist, Registered Nurse
Location
Pennsylvania
Posted
9 days ago
Salary
0
Seniority
Mid Level
Job Description
Clinical Triage Specialist, Registered Nurse
St. Luke's University Health Network
• Answers telephones, prioritizes clinical triage calls, follows clinical protocols, and coordinates services, as needed. • Verifies patient demographic information and accurately enters the updated information into electronic health record. • Serves as an escalation point for clinical patient issues and other POD team members requiring clinical support, and provides clinical advice based on clinical protocols and procedures. • Manages and responds to escalated electronic patient messages whenever not answering inbound patient calls and uses clinical judgment to prioritize and accommodate patients. • Creates a positive patient experience at every encounter, attempting to independently resolve any issues or concerns of the patient at the time of the phone call, within the scope of the role. • Consistently meets productivity, schedule adherence, and quality standards as set by the Access Center. • Utilizes all resources and guidelines at his/her disposal to effectively assess, prioritize, advise, schedule appointments, or refer calls when necessary to the appropriate medical facility or personnel. • Accurately documents symptoms/complaints, nursing assessment, advice provided and patient/caller response. • Partners with other Access Center teams/PODs and respective practice clinical team on behalf of the patient to assist with clinical concerns, medication refills, or scheduling appointments. • Other duties as assigned.
Job Requirements
- Graduate of an accredited nursing program
- Active Registered Nurse licensure in the state of Pennsylvania and New Jersey or other nursing compact state and other states as deemed necessary by state law.
- Minimum 2 years recent clinical experience in a physician office, home health, critical care and/or emergency room is required.
- Strong communication skills
- Focused on compliance
- Demonstrates continuous growth
- Quality-driven
- Service-oriented
- Excels at time management
- Strong problem-solving skills
- Ability to work from home in accordance with the Network Work from Home Policy if needed.
Benefits
- Health insurance
- 401(k) matching
- Flexible working hours
- Paid time off
- Remote work options
Related Guides
Related Job Pages
More Clinical Specialist Jobs
• The Clinical Education Specialist Lead is responsible for the strategic design, preparation and execution of hands-on training experiences for Professional Education under North America Global Education Solutions. • Supports R&D, Marketing, Education Grants, and Meetings and Conventions. • Partner with colleagues to effectively teach and train on the safe and efficacious use of Johnson & Johnson products in a lab setting to external Healthcare Professional customers. • Serve as the subject matter expert on anatomy, language of medicine, clinical procedures, disease states and all Johnson & Johnson technologies. • Collaborate and align priorities with Sales, Professional Education, R&D, and Marketing leaders to develop customized hands-on educational experiences that meet the goals and needs of multiple stakeholders. • Manage priorities and timelines well and be comfortable in a fast-paced environment. • Ensure compliance to all legal, regulatory and HCC policies to include Advamed, Pharma, ACCME, AATB and other global legal and regulatory bodies. • Ensure all field based programs are compliant with J&J guidelines through thorough formal on-site assessment of field based sites. • Support the DePuy Synthes operating business, prior experience in Sports Medicine or Joint Reconstruction medical devices is preferred.
Nurse Specialist – Clinical Denials and Appeals
HuronHuron is a global professional services firm elevating the vision of what's possible and then putting it into practice.
• Responsible for reviewing the claims denied and carrying out the appeals process appropriately and in a timely manner • Identifies and works denials, responding to the denial reason and resubmitting any information needed to the payor • Work denials and appeals timely, evaluating the denial reason including information from the payor and payor policies, reviewing the clinical documentation, assessing options and completing next steps • Submit retro-authorizations in accordance with payor requirements in response to authorization denials • Conducts medical necessity reviews, based on denial root cause, and prepares any required clinical documentation summaries to accompany appeals. • Write and submit written appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language • Document all actions taken and follow-up timely as needed related to resolving denials and appeals with third-party payers in a timely manner • Completes relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms • Complies with state and federal regulations, accreditation/compliance requirements, and Huron’s policies, including those regarding fraud and abuse, confidentiality, and HIPAA
• Leader for product demonstrations across the region • Joint sales visits for Strategic Accounts with Sales Representatives after 30% sales probability • Drive client engagement for the region and work with Key accounts • Address the clinical queries of end users within the defined turn-around time • Work collaboratively with the Marketing Function
• Assist in the preparation of regulatory submissions and impact assessments. • Perform clinical evaluation plans and reports • Perform literature searches and reviews • Work with regulatory agencies and partners worldwide to achieve market access and compliance. • Comply with the quality management system and ISO 13485. • Ensure compliance with regulations. • Explain regulations, policies, or procedures. • Provide technical review of data and reports. • Coordinate clinical documentation activities. • Update Clinical Evaluation Reports on an annual basis. • Document Compliance with GSPR(s) • Update Annual Post-Market Surveillance Reports




