Job Overview: A Registered Nurse (RN) accredited by the Philippine Health Insurance Corporation (PHIC) plays a critical role in providing quality healthcare services in accordance with PHIC's guidelines and policies.
The nurse is responsible for delivering direct patient care, coordinating treatments, and ensuring the efficient utilization of PhilHealth benefits for patients.
They also work closely with doctors, healthcare professionals, and administrative staff to ensure accurate documentation and the timely submission of claims for PhilHealth reimbursement.
Key Responsibilities: Patient Care and Support:Provide direct nursing care to patients by assessing their health status, monitoring vital signs, administering prescribed medications, and managing treatments.Perform nursing procedures such as wound care, catheterization, intravenous (IV) therapy, and other clinical tasks within the scope of practice.Ensure patients' comfort and safety by assisting with activities of daily living and responding to patient needs promptly.Monitor patient responses to treatment and medication, and report any significant changes in condition to the attending physician.PHIC Documentation and Claims:Accurately document patient care activities, including assessment data, interventions, progress notes, and outcomes in the patient's medical record, as required by PHIC.Assist patients in understanding their PhilHealth coverage and the benefits available for hospitalizations, surgeries, diagnostic procedures, and outpatient services.Ensure proper documentation for PHIC claims and verify that all services rendered to the patient are covered by PhilHealth benefits.Collaborate with the hospital's billing or administrative department to ensure the timely submission of PhilHealth claims and resolve any issues regarding claims processing.Patient Education:Educate patients and their families about their medical conditions, treatment plans, and the utilization of their PhilHealth benefits.Provide information on preventive healthcare, lifestyle modifications, and post-treatment care to promote health and well-being.Offer guidance on proper medication adherence, rehabilitation protocols, and the importance of follow-up visits.Coordination with Healthcare Team:Work collaboratively with physicians, specialists, allied healthcare workers, and administrative staff to deliver comprehensive care and treatment plans.Participate in rounds and clinical meetings to discuss patient care and ensure all members of the healthcare team are informed of patient progress.Coordinate with other departments (e.g., pharmacy, laboratory, radiology) to facilitate diagnostic testing, treatments, and procedures covered by PhilHealth.Infection Control and Safety:Adhere to safety protocols and infection control guidelines to minimize the risk of healthcare-associated infections (HAIs).
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