Claims Examiner, Sr. jobs in Jacksonville, FL

DUTIES

To provide nursing care, in accordance with the patient's plan of care, to include comprehensive health and psychosocial evaluation, monitoring of the patient’s condition, health promotion and prevention coordination of services, teaching and training activities, and direct nursing care.

RESPONSIBILITIES

Coordinate total patient care by conducting comprehensive health and psychosocial evaluation, monitoring the patient's condition, promoting sound preventive practices, coordinating services, and teaching and training activities.

Evaluate the effectiveness of nursing service, to the patient and family, on an ongoing basis.

Perform admission, transfer, re-certification, resumption of care, and discharge OASIS for the home care patient.

Prepare, and present, patient's record to the Clinical Record Review Committee, as indicated.

Consult with the attending physician, concerning alterations of Patient Care Plans, checks with the appropriate supervisor, and makes changes, as appropriate.

Coordinate patient services.

Submit a tally of patient care visits made each day.

Participate in case conferences, discuss with the supervisor problems concerning the patients, and how they may best be handled.

Discuss, with the appropriate supervisor, the need for the involvement of other members of the health team, such as the Home Health Aide, the Physical Therapist, the Speech Therapist, the Occupational Therapist, The Medical Social Worker, etc.

Cooperate with other agencies providing nursing, or related, services to provide continuity of care and to implement a comprehensive care plan.

Participate in staff development meeting.

Continually strive to improve his/her nursing care skills by attending in-service education, through formal education, attendance at workshops, conferences, active participation in professional and related organizations, and individual research and reading.

Participate in the development, and periodic revision, of the physician's Plan of Treatment and processes change orders, as needed.

Submit clinical notes, within 48 hours, and progress notes and other clinical record forms outlining the services rendered.

Participate in the patient’s discharge planning process.

Maintain an on-going knowledge of current drug therapy.

Adhere to federal, state, and accreditation requirements, including Medicare and Medicaid regulations.

May be requested, by Clinical Manager, to fill in for the other nurses.

COORDINATES THE ADMISSION OF A PATIENT TO THE AGENCY

Conduct an initial, and ongoing, comprehensive assessment of the patient’s needs, including Outcome and Assessment Information Set (OASIS) assessments, at appropriate time points.

Obtain a medical history from the patient, and/or a family member, particularly, as it relates to the present condition.

Conduct a physical examination of the patient, including vital signs, physical assessment, mental status, appetite, and type of diet, etc.

Evaluate the patient, family member(s), and home situation, to determine what health teaching will be required.

Evaluate the patient's environment to determine what assistance will be available, from family members, in caring for the patient.

Evaluate the patient's condition, and home situation, to determine if the services of a Home Health Aide will be required and the frequency of this service.

Explain nursing, and other Agency, services to patients and families, as a part of planning for care.

Develop, and implement, the nursing care plan.

May be requested, by the Clinical Manager, to fill in for other nurses who are on vacation or sick.

PROVIDES SKILLED NURSING CARE AS OUTLINED IN THE NURSING CARE PLAN

Nursing services, treatments, and preventative procedures, requiring substantial specialized skill and ordered, by the physician.

The initiation of preventative and rehabilitative nursing procedures, as appropriate, for the patient's care and safety.

Observing signs, and symptoms, and reporting to the physician: reactions to treatments, including drugs, as well as changes in the patient's physical, or emotional, condition.

Teaching, supervising, and counseling the patient, and caregivers, regarding the nursing care needs and other related problems of the patient, at home.

ASSUMES RESPONSIBILITY FOR THE CARE GIVEN BY THE HOME HEALTH AIDE

Supervise, and evaluate, the care given by the Home Health Aide, as needed, and at a minimum of, once every 14 days.

Submit, to the appropriate department/individual, written evaluations of the Home Health Aides who are providing service to the patients, in his/her geographical area.

Participate in periodic conferences, with the Home Health Aide supervisor, concerning the Aide's performance.

Chart those services rendered to the patient, by the staff nurse, and changes that have been noted, in the patient's condition and/or family and home situation, makes revisions in the nursing care plan, as needed, records supervisory visits conducted with the Home Health Aide, evaluates patient care and progress, and closes charts of discharged patients.

Evaluate the effectiveness of her nursing service to the individual and family.

Discuss, with the supervisor, the need for involvement of other members of the health team, such as the Home Health Aide, physical therapist, speech therapist, occupational therapist, social worker, etc.

Obtain orders for home health aide service and submit referrals to appropriate personnel.

Provide guidance, and supervision, to the LPN and supervises the LPN, once monthly.

Cooperate with other agencies providing nursing, or related, services to provide continuity of care and to implement a comprehensive care plan.

Participate in the educational experiences for student nurses.

Participate in the planning, operation, and evaluation of the nursing service.

Prepare the care plan for the Home Health Aide.

JOB CONDITIONS

Must have a driver’s license and be willing, and able, to drive to patients’ residences.

The ability to access patients’ homes, which may not be routinely wheelchair accessible, is required. Hearing, eyesight, and physical dexterity must be sufficient to perform a physical assessment of the patient's condition and to perform and demonstrate patient care.

Physical activities will include, walking, sitting, stooping, and standing and minimal to maximum lifting of patients and the turning of patients.

The ability to communicate, both, verbally, and in writing, is required as frequent communication, by telephone, and in writing in English, is required.

EQUIPMENT OPERATION

Thermometer, B/P cuff, glucometer, penlight, hand washing materials.

COMPANY INFORMATION

Has access to all patient medical records, personnel records, and patient financial accounts, which may be discussed with the Clinical Manager.

QUALIFICATIONS

1. Must be a graduate from an accredited School of Nursing.

1. Must be licensed in the state of Florida, as a Registered Nurse.

1. One, or more, years of experience, in community/home health agency or in a hospital setting, is preferred.

1. Must have knowledge of Medicare and Medicaid guidelines.

1. Must have a working knowledge of home healthcare, and the principles and techniques of professional nursing, and required documentation that pertains to it.

1. Should be skillful in organization, and in the principles of time management, and have knowledge of management processes.

1. Must be able to contribute to the quality of care being rendered, through constructive communication with nursing managers and staff.

1. Must have a criminal background check.

1. Must have a current CPR certification. Online certification is not accepted.