LPN Clinical Specialist

JOB SUMMARY:

The Clinical Specialist 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:

1. Handles outbound and inbound calls and emails from external and internal customers.

2. 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.

3. Facilitates timely messages for the care team by accurately recording information in the EHR system and tasking information to the correct individual.

4. Follows up complicated customer calls where required.

5. Completing call logs and call reports as necessary and updating them in the EHR/EPM.

6. Obtains appropriate prior authorization as necessary for medications, tests referrals etc.

7. Processing forms, orders, and applications requested by the customers internal and external.

8. Maintains confidentiality of patient's medical information and work materials as appropriate.

9. Participates in Care teams quality improvement activities.

10. Utilizes established clinical protocols and policies and procedures to assist patients and external customers as appropriate.

11. Documents properly all treatments, medications, lab results, phone messages, referrals, etc.

12. Must utilize skilled listening techniques.

13. Research required information using accessible resources.

14. Responds to Crisis/Red Flag calls and refer to care team staff as appropriate. Follows through with patient and care team staff until resolution.

15. Participates in internal and external educational opportunities relevant to the call center or customer service environment including but not limited to care coordination and case management in-service and training.

16. Involving the patients in activities to improve their health (patient engagement) Uses skills for patient assessment and implements patient teaching/education/ self-management.

17. Participate in the appropriate training sessions, maintain CEU's as required by the State Nurses Licensure Board if applicable.

18. Utilizes RTS system to verify patients insurance at each contact. Update the insurance information in the EHR as changes are identified.

19. 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.

20. Is cross trained in other call center areas and will be expected occasionally to work in other call center areas as necessary.

21. Any other duties deemed necessary by immediate supervisor.