Status:  PRN - As Needed

Shift:     Varies

Exempt: No 

Other information:

Education:
Graduate of an accredited RN program

Licensure/Certification/Registration:
Registered Nurse currently licensed to practice in the State of Louisiana

Experience/Skills:
Minimum two years of clinical nursing experience of which were in direct patient care areas. 
Emergency services and/or utilization review/case management experience preferred. 
Knowledge of Prospective Payment System, DRG’s, and Peer Review Organizations preferred.
Surgery/ICU/ER training preferred.
Knowledge of ICD-9-CM coding preferred.
Basic Computer skills preferred.
Knowledge of Milliman and EPIC system is desirable.

Physical Demands:
Strength: Sedentary
Push: Occasionally
Pull: Occasionally
Carry: Occasionally
Lift: Occasionally
Sit: Frequently
Stand: Ffrequently
Walk: Frequently

Responsibilities:

1.Patient Flow Navigator Nurses (PFNN) are either assigned to ED or Transfer Center and job duties are as follows:

a.Screen all patients for admission including Emergency Dept. admissions, Direct Admissions as well as Transfers in from other facilities, or Transfers between units for medical necessity, appropriate status, and appropriate level of care.

b.Performs initial clinical review on patients being admitted and documents information in appropriate electronic system, and effectively communicates findings to Transfer Center and / or other hospital personal as necessary for optimal patient flow.

c.Receives bed request and performs or reviews screen to ensure medical necessity appropriate status, level of care and placement of patients and assign a bed.

d.Works conjunctively with all hospital personnel to determine appropriate patient placement and bed assignment.

e.Provides recommendations for alternative levels of care, status, and placement, and secures appropriate orders from MD.

f.Reviews admission orders for all patients being admitted during shift to ensure all required components for billing are present.

g.Serves as an information resource regarding insurance benefits and coverage to patients, caregivers, hospital and Medical Staff on patients being admitted.

h.Refers any cases which do not follow established medical necessity, status, or level of care processes to dept. Supervisor/Manager, Director, and/or Physician Advisor.

i.Serves as “on-call” Case Manager for the hospitals after normal business hours.

j.Manages inter and intra-facility transfers, direct admissions, and status changes twenty four hours per day, seven days per week and refers requests for post-discharge referrals to community agencies to the Social Worker II assigned to the ED during worked hours.

k.Acts as a liaison / resource for physician office personnel planning for Direct Admissions, and other facilities planning for transfers.

l.Receives bed requests from all procedural areas to review for medical necessity, appropriate status, and level of care and determine placement and distribute bed assignment.

m.Reviews daily admission list to ensure all initial clinical reviews were performed on all previous days’ admissions, and audits for appropriate medical necessity / status placement

n.Reviews all patients remaining in Observation Status after midnight for medical necessity and possible inpatient conversion and communicates with Observation Charge Nurse / Observation UR Nurse / Attending Physician / Physician Advisor by 6:45am daily including level of care recommendation and possible bed placement.

o.Works conjunctively with Nursing Supervisors / Charge Nurses / Nursing Managers / Procedural areas to proactively plan for house-wide patient flow plan and continuous bed management.

p.Reports daily Bed / Pt. Flow plan to all areas as determined by Nursing Administration by 4:30am and 4:30 pm.

q.Assists in frequent patient reviews for level of care appropriateness and optimal bed usage.

r.Supports CM Plan of Care by completing quality audits and reporting information related to metrics to Supervisor/Manager/Director.

s.Gathers data on patient flow metrics and reports daily to supervisor for trending.

t.Works closely with Physician Advisor to trend issues requiring additional education for physician and nursing staff throughout the organization.

u.In the absence of a Social Worker, assesses and documents patient’s psychosocial and discharge planning needs and collaborates with the physician for further treatment and discharge/transfer planning.
In the absence of a Social Worker, makes appropriate referrals to discharge planning, continuum of care, abuse, neglect and/or exploitation with all necessary information to other agencies/resources to ensure continuity of care. Works to place PEC/CEC patients for psychiatric treatment needs.

2.Follows North Oaks Health System’s Compliance Programs and Federal and State Regulatory guidelines.

3.Follows North Oaks Health System Infection Control guidelines and practices.

4.Follows North Oaks Health System guidelines and practices related to HIPAA.

5.Other duties as deemed necessary and appropriate.