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Provides skillful, non-face-to-face telephone triage, care, and planning to Medicare patients who have 2 or more chronic conditions
Follow accepted evidence-based guidelines and protocols, and document encounters appropriately in patient charts
Collaborate with physicians and the healthcare team to optimize care
Triage Leads
Download notes from Triage Vendor, add to patient charts in CCM, and follow up with patients/providers
Be on-call during assigned Triage Lead shifts during the month to answer questions as needed
Nurse Urgent Queue
Educates and coaches to find creative ways to assist patients in reaching their health goals
Review and complete Nurse Urgent To-Do’s, with a goal to keep the queue below 50
Communicate with patients and providers to assist in answering questions, coordinating care, and services. (examples: schedule appointments, contacting service providers, sending notifications to healthcare providers, calling the patient back to follow up on their recent urgent or emergent medical issue, etc.)
Attend meetings as required by the position
Other duties as assigned
Requirements
Skills and Qualifications
Fluent/Bilingual in Spanish
Willing and able to work Monday – Friday 3:30 pm - 12:30 am EST
Possess a current COMPACT license as an RN
Willing to obtain multi-state licenses of ChartSpan footprint
Familiar with chronic care conditions and the medications used to treat chronic conditions such as HTN, CHF, COPD, DM, etc.
Excellence in following clinical triage protocols and procedures, and documenting accordingly in patient charts
Recognize the acute onset of symptoms that might require immediate attention
Demonstrate sound knowledge, critical thinking skills, and appropriate decision-making skills
Demonstrate sensitivity and empathy with patients
Demonstrate excellent verbal and written communication skills
Possesses excellent computer skills with the ability to multitask, including navigating and documenting in an EMR while communicating with the patient and using a telephonic platform
Willing to work an on-call rotating schedule as needed