Job Description

ABOUT THE POSITION

We are currently seeking a dynamic RN REVIEWER, PDIPto join our team at our office in WOBURN, MA. ThePSYCHOTROPIC DRUG INTERVENTION PROGRAM (PDIP)is a unique, comprehensive, and integrated quality management program focused on identifying claims-based, medication-related problems including medication safety issues through the use of informatics, analytics, and clinical review. The program engages both prescribers and members, utilizing innovative technologies to achieve an understanding and resolution of medication related issues.

Position Responsibilities:

Weekly clinical review of medication-related problems in order to determine an appropriate intervention decision. Includes but not limited to reviewing polypharmacy, coordination of care and suboptimal dosing issues as well as potential non-adherence cases. When needed, escalate cases for medical review when appropriate.
Monthly clinical review of safety gaps in care and addiction management algorithm output. When needed, escalate cases for medical review when appropriate
Meet guidelines for established metrics of both quantity and quality performance.
Address and track all related questions and concerns of providers and/or members related to medication-related problems or other PDIP clinical initiatives
Assist in integration of PDIP process findings and history with other company departments such as care management.
Attend PDIP clinical meeting, for the purpose of group supervision and aligning practice within the department, expert discussion topics as needed with Beacon s physician advisor or pharmacist(s).
Identify programmatic needs, identify and communicate patterns of concern, problem solving with technical teams as required.
Provide risk characterization analysis and provider/member review for the drugs of abuse program.
Participate in algorithm development and management with PDIP s analytic department and clinical team.
Attend and present at PDIP internal and external meetings.
Assist PDIP s analytic department with clinical perspective and data analysis including high-risk co-morbidities and treatment utilization drivers.
Coordinate quality testing process for new algorithm development, new client implementation and troubleshooting assessment.
Other duties as assigned.

Position Requirements:

Education: BSN Degree preferred

License(s): RN

Relevant Work Experience:A minimum 2 years experience in healthcare, behavioral health or human services. Reliable knowledge of MS Office, experience with electronic medical records.

Knowledge, Skills & Abilities:

Knowledgeable of prevalent behavioral health diagnoses including addiction and associated comorbidities.
Knowledgeable of commonly prescribed medications used in behavioral health condition management.
Knowledgeable of common medication-related problems such as patient non-adherence, polypharmacy and suboptimal dose prescribing and the processes to manage then.
Understanding of managed care health insurance models.
Experience in developing process, monitoring documentation of procedures.
Strong analytical and problem solving abilities.
Interpersonal communication skills and includes both verbal and written.
Collaboration and team-oriented work philosophy.

TO APPLY

Click below on Apply for this Position to create a profile and apply for the position

Beacon Health Options company is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

$REM

This job was posted on Fri Aug 24 2018 and expired on Sat Aug 25 2018.

Minimum $42K /yr

$87K /yr Average

Maximum $136K /yr

Tasks

Collaborate with other health care professionals and service providers to ensure optimal patient care.

Provide consultation to other health care providers in areas such as patient discharge, patient care, or clinical procedures.

Develop or assist others in development of care and treatment plans.

Develop and maintain departmental policies, procedures, objectives, or patient care standards, based on evidence-based practice guidelines or expert opinion.

Read current literature, talk with colleagues, or participate in professional organizations or conferences to keep abreast of developments in nursing.

Evaluate the quality and effectiveness of nursing practice or organizational systems.

Develop, implement, or evaluate standards of nursing practice in specialty area such as pediatrics, acute care, and geriatrics.

Design evaluation programs regarding the quality and effectiveness of nursing practice or organizational systems.

Plan, evaluate, or modify treatment programs, based on information gathered by observing and interviewing patients or by analyzing patient records.

Direct or supervise nursing care staff in the provision of patient therapy.

Instruct nursing staff in areas such as the assessment, development, implementation and evaluation of disability, illness, management, technology, or resources.

Monitor or evaluate medical conditions of patients in collaboration with other health care professionals.

Design patient education programs that include information required to make informed health care and treatment decisions.

Provide specialized direct and indirect care to inpatients and outpatients within a designated specialty, such as obstetrics, neurology, oncology, or neonatal care.

Make clinical recommendations to physicians, other health care providers, insurance companies, patients, or health care organizations.

Maintain departmental policies, procedures, objectives, or infection control standards.

Present clients with information required to make informed health care and treatment decisions.

Perform discharge planning for patients.

Identify training needs or conduct training sessions for nursing students or medical staff.

Participate in clinical research projects, such as by reviewing protocols, reviewing patient records, monitoring compliance, and meeting with regulatory authorities.

Lead nursing department implementation of, or compliance with, regulatory or accreditation processes.

Observe, interview, and assess patients to identify care needs.

Write nursing orders.

Chair nursing departments or committees.

Develop nursing service philosophies, goals, policies, priorities, or procedures.

Coordinate or conduct educational programs or in-service training sessions on topics such as clinical procedures.

Teach patient education programs that include information required to make informed health care and treatment decisions.

Prepare reports to document patients' care activities.

Provide direct care by performing comprehensive health assessments, developing differential diagnoses, conducting specialized tests, or prescribing medications or treatments.

Skills

Reading Comprehension - Understanding written sentences and paragraphs in work related documents.

Active Listening - Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.

Writing - Communicating effectively in writing as appropriate for the needs of the audience.

Speaking - Talking to others to convey information effectively.

Science - Using scientific rules and methods to solve problems.

Critical Thinking - Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.

Active Learning - Understanding the implications of new information for both current and future problem-solving and decision-making.

Learning Strategies - Selecting and using training/instructional methods and procedures appropriate for the situation when learning or teaching new things.

Monitoring - Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.

Social Perceptiveness - Being aware of others' reactions and understanding why they react as they do.

Coordination - Adjusting actions in relation to others' actions.

Persuasion - Persuading others to change their minds or behavior.

Negotiation - Bringing others together and trying to reconcile differences.

Instructing - Teaching others how to do something.

Service Orientation - Actively looking for ways to help people.

Complex Problem Solving - Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.

Operations Analysis - Analyzing needs and product requirements to create a design.

Judgment and Decision Making - Considering the relative costs and benefits of potential actions to choose the most appropriate one.

Systems Analysis - Determining how a system should work and how changes in conditions, operations, and the environment will affect outcomes.

Systems Evaluation - Identifying measures or indicators of system performance and the actions needed to improve or correct performance, relative to the goals of the system.

Time Management - Managing one's own time and the time of others.

Management of Personnel Resources - Motivating, developing, and directing people as they work, identifying the best people for the job.

Knowledge

Administration and Management - Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.

Customer and Personal Service - Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.

Computers and Electronics - Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.

Mathematics - Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.

Biology - Knowledge of plant and animal organisms, their tissues, cells, functions, interdependencies, and interactions with each other and the environment.

Psychology - Knowledge of human behavior and performance; individual differences in ability, personality, and interests; learning and motivation; psychological research methods; and the assessment and treatment of behavioral and affective disorders.

Sociology and Anthropology - Knowledge of group behavior and dynamics, societal trends and influences, human migrations, ethnicity, cultures and their history and origins.

Medicine and Dentistry - Knowledge of the information and techniques needed to diagnose and treat human injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures.

Therapy and Counseling - Knowledge of principles, methods, and procedures for diagnosis, treatment, and rehabilitation of physical and mental dysfunctions, and for career counseling and guidance.

Education and Training - Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects.

English Language - Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.

Philosophy and Theology - Knowledge of different philosophical systems and religions. This includes their basic principles, values, ethics, ways of thinking, customs, practices, and their impact on human culture.