Registered Nurse (RN), Care Command (PRN)

Job Summary

The Access Care Manager (CM) is responsible for managing the entry and coordination of patients into the hospital. He/she will address issues related to the planning, execution, and management of bed placement of all admissions from all entry points into the hospital (e.g. EC, direct admits, transfers, etc.) in accordance with the clinical standards and guidelines set forth by Phoebe Putney Memorial Hospital. The Access CM performs admission clinical reviews for appropriate level of care and patient status, and is responsible for ensuring that patients are admitted to the most appropriate bed available to meet their clinical needs using established criteria for admission. All patient transfer activities will follow EMTALA regulations and guidelines.

Qualifications

• Associate Degree in Nursing required
• Bachelor's Degree in Nursing preferred

Work Experience

• 3 years progressive clinical and basic management experience required

Licenses and Certifications

• Registered Nurse (RN) with current Georgia license

Essential Functions

Effective Communication with Care Management, Nursing, Physicians, and Other Disciplines

This individual will be able to effectively discuss with the appropriate discipline any needs related to the appropriate placement and correct admit status on any and all patients.

• Ability to maintain patient confidentiality and follow applicable hospital and department policies and work instructions.
• Demonstrate effective communication and team building skills.
• Ability to think outside of the box in decision making processes.

Job Knowledge - Access Care Manager

• Understands and fulfills job responsibilities and expectations and applies knowledge and skills to function proficiently in Access CM role.
• Serves as Patient Advocate in support of Hospital mission and goals.
• Maintains knowledge of current federal, state, and accreditation requirements applicable to utilization review; demonstrates compliance and skill in the application of this knowledge.
• Possesses current and comprehensive skill and knowledge to perform all parts of the job effectively and efficiently.
• Exhibits ability to learn and apply new skills, professional knowledge, and expertise.
• Requires minimal day-to-day direction to perform responsibilities.
• Serves as a resource and is able to share best practices and answer questions as needed.
• Has knowledge of EMTALA regulations and applies this on a consistent basis according to scope of role and decision making.
• Educates physicians and others about regulatory and payer issues that impact admission or transfer process.

Access CM Utilization Review, Documentation & Electronic System

• Performs UR functions, documents and records review activity, follow up and outcomes in the appropriate electronic system as required; assures documented/recorded information and data are timely and inclusive of pertinent facts.
• Clearly and accurately documents UM related reviews, referrals, activities related to utilization review.
• Ensures that documentation is tailored to expected readers/users.
• Uses correct terminology in accordance with hospital standards and conforms to required style and format.
• Applies medical staff approved clinical criteria to reviews and in accordance with payer standards and requirements.
• Performs review of transfer or admission documents according to established clinical criteria and standards; reviews questions regarding level of care with admitting physician or designee; refers issues or questions of medical necessity to physician advisor.
• Seeks guidance or escalates cases to Team Lead or Director CM for direction or administrative support.
• Provides timely notification to Admitting physician.
• Follows EMTALA regulations and reviews payer information to determine if requirements for authorization may impact patient or hospital liability and refers to appropriate area for action.

Access CM - Leadership

• Engages in teamwork as a team player and a team leader.
• Educates staff, physicians, and patients about the role of Access Care Manager.
• Serves on committees or participates in projects at work with opportunities for shared decision making and being a change agent.
• Promotes professionalism of care management role through participation in professional organizations.
• Incorporates evidence-based knowledge in practice.

Performance Improvement and Outcomes - Access Center Setting

• Identifies actions and strategies that positively impact care coordination, efficiency, and effectiveness.
• Uses creativity and innovation to improve Access CM work, patient flow, and hospital efficiency.
• Identifies patterns or trends that can positively impact reduced readmissions.
• Assesses patterns, trends, or root cause of readmission for individual patient or across settings.
• May refer to social worker, care manager, nursing, physician, and others to proactively address patient specific issues to avert future readmits.
• Incorporates evidence-based knowledge to initiate change.
• Participates in quality improvement activities.

Additional Duties

• Adheres to the hospital and departmental attendance and punctuality guidelines.
• Performs all job responsibilities in alignment with the core values, mission, and vision of the organization.
• Performs other duties as required and completes all job functions as per departmental policies and procedures.
• Maintains current knowledge in present areas of responsibility (i.e., self-education, attends ongoing educational programs).
• Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.
• Demonstrates competency at all levels in providing care to all patients based on age, sex, weight, and demonstrated needs.

For non-clinical areas, has attended training and demonstrates usage of age-specific customer service skills. Wears protective clothing and equipment as appropriate.