This position is responsible for conducting client assessments by phone to determine individual needs for incontinence products.
- Consults by phone with client, primary caregiver, primary care physician or specialist, case managers and other community resources to determine if client qualifies for a particular program. Expectation is that Nurse will complete 20-25 assessments daily, on average.
- Conducts clinical assessments by phone and documents the client’s medical history, the incontinence challenge, abilities to toilet and perform activities of daily living. Monitors success rates, if the client is in a toilet training, bladder or bowel training program. All products ordered must be assessed for use and quantity needs per day.
- Identifies appropriate product and quantity needs based on assessment. If formulary product will not meet needs, then reviews needs and potential solutions with Nurse Manager.
- Reassesses if there is a change in a client’s medical condition or an increase in quantity request.
- Obtains prior authorization from the state contract administrator for off-formulary or over-quantity requests.
- Reviews letters of medical necessity to determine if client qualifies for product or quantity requested.
- Reviews accounts for accuracy, reporting any errors to the appropriate department manager/leader.
- Participates in after-hours emergency call rotation.
- Understanding of insurance guidelines.
- Utilize intranet tools to complete assessments.
- Provides education to other J & B employees or external clients regarding incontinence and products.
- Ensures Accountability
- Action Oriented
- Communicates Effectively
- Customer Focus
- Decision Quality
- Values Differences
- Situational Adaptability
- Balances Stakeholders
- Instills Trust
This position has no supervisory responsibilities
This job operates in a call center office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
This is a largely sedentary role. Individuals may need to sit or stand as need. This position may occasionally lift up to 25 pounds for files, samples and supplies.
This is a full-time position. Days are Monday through Friday and hours of work vary between 8:00am to 6:00pm. Occasional early mornings, evening and weekend work may be required as job duties demand.
No travel required for this position.
Required Education and Experience:
- Current Registered Nursing License (RN) with the State of Michigan
- 2+ years previous work experience demonstrating patience, compassion and strong communication skills
Preferred Education and Experience:
- 3 years of nursing experience
- Knowledge of medical terminology
- Medicare and Medicaid background
- Durable Medical Equipment (DME)
Additional Eligibility Qualifications:
None required for this position.
All other duties as assigned by management. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are request of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.