LPN CLINICAL SPECIALIST

Job DetailsJob Location: Medical Mall MLK - MOBILE, AL 36527
JOB SUMMARY:   The Clinical Specialist, LPN will respond to incoming calls from internal and external customers to take their requests, answer questions and inquiries, troubleshoot problems, provide information/education and attempt to resolve informal complaints regarding services. The Clinical Specialist will handle clinical calls from patients/customers manage, coordinate and direct inbound calls for Franklin care teams at multiple locations, including but not limited to simple transfers, informational/educational calls, appointment scheduling, referral requests, medication refills, and medical inquiry. Promptly answers, screens, and processes medical service requests and telephone inquiries with strict adherence to confidentiality agreements, established protocols and policies and procedures. Works closely and immediately facilitates patient access to the care team when needed to assist with patient care needs. Facilitates care coordination and case management activities to support the care team as appropriate.

ESSENTIAL FUNCTIONS: 

Handles outbound and inbound calls and emails from external and internal customers
Answers telephone in a courteous, professional, and efficient manner.  Obtains and records caller's name, time of call, nature of business, and person called upon.
Facilitates timely messages for the care team by accurately recording information in the EHR system and tasking information        to the correct individual.
Follows up complicated customer calls where required.
Completing call logs and call reports as necessary and updating them in the EHR/EPM.
Obtains appropriate prior authorization as necessary for medications, tests referrals etc…
Processing forms, orders, and applications requested by the customers internal and external.
Maintains confidentiality of patient's medical information and work materials as appropriate.
Participates in Care team’s quality improvement activities
Utilizes established clinical protocols and policies and procedures to assist patients and external customers as appropriate
Documents properly all treatments, medications, lab results, phone messages, referrals, etc…
Must utilize skilled listening techniques
Research required information using accessible resources.
Responds to Crisis/Red Flag calls and refer to care team staff as appropriate. Follows through with patient and care team staff               until resolution.
Participates in internal and external educational opportunities relevant to customer service environment         including but not     limited to care coordination and case management in-service and training.
Involving the patients in activities to improve their health (patient engagement) Uses skills for patient assessment and            implements patient teaching/education/ self-management. 
Participate in the appropriate training sessions, maintain CEU's as required by the State Nurses Licensure Board if applicable.
Utilizes RTS system to verify patient’s insurance at each contact. Update the insurance information in the EHR as changes are              identified.
Supports provider meaningful use efforts by collecting necessary information such as but not limited to pharmacy utilized by          patient, email address, other providers seen, etc.
Is cross trained in other call center areas and will be expected occasionally to work in other call center areas as necessary
Any other duties deemed necessary by immediate supervisor and/or Director of Outreach/Care Coordination.       

TELEPHONE ASSESSMENT AND EVALUATION

telephone assessment of symptoms and active problems must be performed by a licensed nurse (LPN or RN)
in the event a licensed nurse is not available, the representative will IMMEDIATELY FACILITATE                the patients access to an appropriate member of the patients care team.

ADDITIONAL RESPONSIBILITIES:

Identifying, escalating priority issues and reporting to the Manager.
Routing inbound calls to the appropriate resources.
Obtaining and evaluating all relevant data to handle requests, complaints and inquiries.
Recording details of requests, comments, inquiries, complaints, and actions taken.
Participates in the organizations Quality assurance program
Displays punctuality and good attendance at work.
Technical expert in related computer applications.
Great communication skills as well as ability to work with others in close manner.
Good keyboard skills and impressive telephone etiquette.
Able to react effectively and calmly in emergencies
Able to maintain customer confidentiality.
Strong communication skills and basic computer knowledge.
Flexibility, proactive and perseverance.
Should be able to operate well under tight pressure.
Able to juggle multiple projects simultaneously.

The preceding examples are representative of the assignments performed by this position and are not intended to be all-inclusive.

CUSTOMER SATISFACTION REQUIREMENTS:  Must provide the very best customer satisfaction to patients and co-workers at all time in a professional and courteous manner.

Actively keeps environment clean and safe with a professional and welcoming image
Actively protects customer confidentiality
Always treats customers as welcome guests and provides a warm and sincere greeting
Consistently presents a professional appearance in dress and grooming by adherence to dress code policy.
Effectively and regularly demonstrates the values of the organization
Effectively involves customers in decisions that affect them
Follows through in a timely manner of commitments made to customers

PERFORMANCE STANDARDS:  Performance will be evaluated by the Director of Outreach/Care Coordination or designee annually by using the Performance Evaluation Form wherein an overall satisfactory rating is considered as a minimum acceptable level of performance.   

HEALTH AND SAFETY REQUIREMENTS:    The health and safety requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Must adhere to safety regulations, personnel policies and procedures.
Must receive Safety and Hazardous Communication training annually.
Maintain yearly health maintenance records by obtaining TB skin testing.

PRIVACY RULE COMPLIANCE REQUIREMENTS:  

Adheres to Health Insurance Portability and Accountability Act (HIPAA Privacy Rule) policies and procedures.
Must successfully complete Privacy Rule compliance training annually or as revisions are made to the policies and procedures.
Must comply with Privacy Rule guidelines by learning to protect FPHC patient’s medical privacy.
Must comply with Privacy Rule guidelines by appropriately maintaining our patient information in compliance with national standards.
Must comply with Privacy Rule guidelines by providing appropriate security of FPHC patient records.

PROTECTED HEALTH INFORMATION (PHI) ACCESS:  RESTRICTED- For purposes of HIPAA Compliance there are 4 workforce categories, which define the level of access to PHI that is granted to the incumbent.  This position is classified under ADMINISTRATIVE STAFF and therefore granted RESTRICTED access- to be defined according to workforce member’s specific job duties. Use and disclosure must be in accordance with applicable privacy policies and procedures

 
QualificationsQUALIFICATIONS:

EDUCATION/EXPERIENCE: Degree with at least 2 years of experience in a health related field. A licensed nursing degree is preferred; will substitute years of experience for degree. Must be experienced in managing multiple duties; possess excellent communications skills, extremely organized, capable of working in a stressful and fast-paced environment and able to communicate effectively.  Problem-solving skills are a must.  Ability to motivate and develop staff is a necessity. Care coordination/case management experience is preferred.

KNOWLEDGE, SKILLS, AND ABILITIES:  Demonstrated knowledge and ability to operate telecommunication equipment efficiently and effectively. Ability to communicate clearly and effectively, both oral and written.

CERTIFICATION, LICENSES, REGISTRATIONS: LPN or higher.

PHYSICAL/MENTAL DEMANDS:  Work is sedentary in nature.  Requires working under stressful conditions.