Registered Nurse-Cardiology Clinic/Utilization Management/Team Lead – Keesler AFB – Biloxi, MS
Leads and directs the utilization review staff and function for a healthcare facility. Determines policies and procedures that incorporate best practices and ensures effective utilization reviews. Manages and monitors both concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way and retrospective reviews after treatment has been completed. Provides analysis and reports of significant utilization trends, patterns, and impacts to resources.
Specific tasks include:
- Receives and makes patient telephone calls and computer/written correspondence regarding specialty clinic appointments and referrals. Routinely monitors referral management CHCS queue to ensure patients are being called that do not utilize the Referral Management Center walk-in service.
- Obtains pertinent information from patients and enters data in CHCS, AHLTA, Military Health System (MHS) Genesis, CliniComp (Essentris), referral database, and other office automation software programs as appropriate.
- Develops and implements a comprehensive Utilization Management plan/program for beneficiaries within the MTF’s goals and objectives.
- Reviews previous and present medical care practices as needed for patterns, trends, or incidents of under or over utilization of hospital resources incidental to medical care provided to beneficiaries.
- Plans and performs reviews in accordance with established indicators and guidelines to provide quality cost-effective care. Ensures identified patient needs are addressed promptly with appropriate decisions. Provides timely, descriptive feedback regarding utilization review issues.
- Performs data/metric collection. Analyzes data and prepares reports to describe resource utilization patterns. Briefs applicable data/slides to provider staff, executive staff, newcomers, as appropriate. Identifies areas requiring intensive management or areas for improvement.
- Collaborates with Referral Management Center to identify all open referrals and ensures resubmission. Ensures all referrals are reviewed and dispositioned in the appropriate manner.
- Establishes and maintains good interpersonal relationships with co-workers, families, peers, and other health team members. Submits all concerns through NCOIC or Flight Commander.
- As Team Lead, acts as the liaison between other Contractor personnel, flight leadership, and employer.
- Assesses patients' conditions for potential or life-threatening crises. Distinguishes between normal and abnormal physical findings. Plans appropriate nursing care. Notifies physician if needed and carries out appropriate interventions as ordered.
- Obtains patient history, pertinent family history, and documents in patient’s medical record.
- Utilizes appropriate nursing personnel to assist in delivery of care when indicated.
- Transcribes or verifies transcription of physician orders.
- Assesses and documents patient response to medications administered and intervenes if desired response is not achieved.
- Instructs patient/family regarding prescribed medications/therapies and invasive/diagnostic procedures that must be accomplished.
- Conducts preoperative and postoperative visits. Discusses cardiac catheterization and diagnostic cardiac testing procedures with patients and informs them of what to expect during procedures. Consults with the physician performing the procedure and establishes priorities of care for each patient.
- Participates in Discharge Planning as appropriate.
- Performs accurate documentation, both written and electronic, of all activity IAW requirements. Prepares all documentation to meet or exceed established standards of the MTF, to include, but not limited to, timeliness, accuracy, content and signature. Only MTF and AF approved abbreviations shall be used for documentation of the patient health record.
- Performs the procedure recovery and discharge within established criteria.
- Serves and participates in committees, functions, and other meetings as directed. Provides relevant and timely information to these groups, and assists with decision-making and process improvement. Participates in customer service.
- Completes orientation and competency verification programs JAW unit guidelines.
- Ensures a safe work environment, employee safe work habits and patient safety JAW regulatory agencies, infection control policies, and process improvement initiatives.
- Maintains national registries, to include the ability to interpret, analyze, edit, and input data into said registries.
- Coordinates cardiac referral process between VA, DoD, and outside facilities for care.
- Attends meetings at either KMC or at the Biloxi VA to discuss VA sharing agreement, cardiology referrals, transfer process, coordination of patient care, etc.
- Performs EKGs and assists echo tech with bubble studies and contrast echoes as needed.
- Assists cardiologist with dobutamine or exercise stress tests within the cardiology laboratory.
- Must possess an Associate’s Degree in Nursing from a college or university accredited by the NLNAC, or The CCNE.
- Must have a minimum of four years of clinical nursing experience and two years of full-time employment in a nursing field within the last 36 months.
- Must have one year of previous utilization management experience within their nursing career.
- Must possess an active, full, and unrestricted nursing license within the jurisdiction Keesler AFB.
- Must possess and maintain a BLS and ACLS/ALS.
- Knowledge, skills, and computer literacy to interpret and apply medical care criteria.
- Possess excellent oral and written communication skills, interpersonal skills, and have working knowledge of computers, specifically the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows.
- Must have a working knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), and ICD.
- Possess the ability to identify, analyze, and make recommendations to resolve problems and situations regarding referrals.
- Be able to independently identify, plan, and carry out projects with consideration for the goals and objectives of the cardiopulmonary flight.
- Possess knowledge of a variety of pharmacological agents used in treatment of patients, the desired effects, side effects, complications, and usual dosage of their use as well as the accurate administration of the pharmacologic agent, including dosage calculations as required.
- Be able to interpret cardiac rhythms and their implications, intervene on emergent changes.
- Must be able to read and speak fluent English.
- Must be able to pass a Federal background check.
Leading Solutions is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity Employer. We are committed to ensuring a workplace free of discrimination based on race, color, religion, age, disability, genetic information, sex, sexual orientation, gender identity, or national origin, military or veteran status, and any other basis protected by applicable law.
Leading Solutions is a Service-Disabled Veteran-Owned Small Business (SDVOSB) and Woman-Owned Small Business (WOSB) headquartered in Kissimmee, Florida. The Company provides professional, technical, administrative, and healthcare services to Government and commercial clients. Leading Solutions customer- centric foundation ensures that our leadership and employees meet customer challenges and build trusting partnerships that lay the groundwork for success.