Patient Support Services Nurse

POSITION SUMMARY: Routinely measures and analyzes quality indicators in conjunction with Managed Care Patient Navigators and clinical teams to support quality improvement, continuity of care, and closure of care gaps. Utilizes sound nursing judgment, clinical preparation, knowledge, skills, and experience to proactively engage patients prior to scheduled visits, perform robust appointment confirmations, support Transitions of Care outreach, and assist with medication reconciliation and follow-up. Places, receives, and routes a high volume of patient and clinic communications, including escalated calls from the Patient Support Services Call Center, to identify barriers to care, coordinate appropriate follow-up, and ensure patients are prepared for visits and post-discharge care. Assists with reporting, auditing, and documentation as required to support CMS, payer, and organizational quality initiatives and to coordinate and monitor the provision of medical services in a professional, patient-centered manner for each individual patient.

POSITION QUALIFICATION REQUIREMENTS

Education: Bachelor of Science Degree in Nursing required.

Experience:

1. Three years' experience in primary care, behavioral health, community health, population health or related field.
2. One year's experience in a customer service, care coordination or call center environment (preferred).
3. Experience in managed care, transitions of care or quality/care gap initiatives (preferred).

Skills and Abilities which may be representative but not all inclusive of those commonly associated with this position:

1. Proficient computer skills including the use of Microsoft Word, Excel and Outlook.
2. Solid experience using an electronic health record.
3. Excellent oral and written communication skills.
4. Detail-oriented and strong organizational skills.
5. Good analytical, critical thinking and problem-solving skills.
6. Ability to manage multiple priorities and tasks simultaneously.
7. Knowledge of managed care insurance plans, CMS, and quality reporting programs.
8. Ability to work independently and as part of a multidisciplinary team.
9. Ability to motivate, educate, and engage patients and staff.
10. Ability to use structured workflows, protocols, and scripts to drive consistent outcomes.
11. Ability to identify barriers to care and escalate appropriately.
12. Ability to use data and reporting to support quality improvement.

Residency and Transportation Requirement: Must possess a valid driver's license and automobile with insurance coverage as required by the State of Missouri.

License(s)/Certification(s) Required:

1. Registered nurse licensed to practice in the State of Missouri
2. CPR Certification

FUNCTIONS OF THE JOB

Essential Functions

1. Performs initial medical triage via telephone or electronic communication for calls routed from the Patient Support Services Call Center, including requests for advice related to acute medical issues, medication concerns, care coordination needs, and patient complaints or concerns.
2. Determines acuity of patient needs and routes appropriately per protocol, including identification of same-day or next-day appointment needs.
3. Proactively engages patients prior to scheduled visits to perform robust appointment confirmations, confirm attendance, identify barriers to care, and prepare patients for visits.
4. Performs Transitions of Care outreach for recently discharged patients, including contact attempts, review of discharge instructions, coordination of follow-up visits, and documentation of outcomes.
5. Supports medication reconciliation by reviewing discharge medication lists, outpatient medication lists, and patient-reported information and escalating discrepancies to providers.
6. Monitors managed care and value-based patient populations for compliance with follow-up visits, preventive care, chronic disease management, and care gap closure.
7. Communicates noncompliance, risks, or barriers to the healthcare team for appropriate intervention.
8. Delivers organized care by prioritizing tasks, adapting to changes in patient condition, and managing competing demands effectively.
9. Communicates with patients, caregivers, providers, and team members in an accurate, timely, professional, and patient-centered manner.
10. Provides health education and counseling to patients and families related to medications, follow-up care, and appropriate use of healthcare services.
11. Collaborates with multidisciplinary teams to identify and resolve barriers to care, reduce no-shows, and support timely care gap closure.
12. Utilizes evidence-based practices and standardized protocols to support care coordination, quality improvement, and access.
13. Maintains accurate, timely, and confidential documentation in the electronic health record and completes required forms and reports.
14. Supports quality reporting, audits, and data collection related to CMS, payer, HRSA, and organizational requirements
15. Performs other duties as assigned.

Marginal Functions:

1. Participates in evaluating, planning, and improving existing and new services and workflows.
2. Assists providers and clinical teams in completing documentation needed to close care gaps and meet quality measures.
3. Serves as liaison between various Affinia Healthcare initiatives, the Patient Services Teams, clinical staff and community partners.
4. Attends group team meetings other agency meetings as required.
5. Perform internal and external audits and quality improvement initiatives to maintain quality and compliance standards.

Supervises: None

NOTE: SMOKING IS PROHIBITED IN THE WORK ENVIRONMENT

NOTE: ALL APPLICANTS MUST PROVIDE CONTACT INFORMATION FOR THREE REFERENCES

AN EQUAL OPPORTUNITY SERVICES PROVIDES ON A NON-DISCRIMINATORY BASIS