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Place of Performance: Keesler AFB, MS
Team Lead Cardiology Utilization Management Nurse shall receive and make patient telephone calls and computer/written correspondence regarding specialty clinic appointments and referrals. Routinely monitors referral management Composite Health Care System (CHCS) queue to ensure patients are being called that do not utilize the Referral Management Center walk-in service.
• Obtain pertinent information from patients and enters data in Composite Health Care System (CHCS), AHLTA, Military Health System (MHS) Genesis, CliniComp (Essentris), referral database, and other office automation software programs as appropriate.
• Develop and implement a comprehensive Utilization Management plan/program for beneficiaries within the Military Treatment Facility’s (MTF’s) goals and objectives.
• Review 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.
• Plan and perform reviews in accordance with (IAW) established indicators and guidelines to provide quality cost-effective care. Ensure identified patient needs are addressed promptly with appropriate decisions. Provide timely, descriptive feedback regarding utilization review issues.
• Perform data/metric collection. Analyze data and prepares reports to describe resource utilization patterns. Brief applicable data/slides to provider staff, executive staff, newcomers, as appropriate. Identify areas requiring intensive management or areas for improvement.
• Collaborate with Referral Management Center to identify all open referrals and ensure resubmission. Ensure all referrals are reviewed and dispositioned in the appropriate manner (whether electronically or manually).
• Establish and maintain good interpersonal relationships with co-workers, families, peers, and other health team members. Submit all concerns through Non-Commissioned Officer in Charge (NCOIC) or Flight Commander.
• Perform with minimal supervisory direction.
• As Team Lead, act as the liaison between other Contractor personnel, flight leadership, and employer.
• Assess patients' conditions for potential or life-threatening crises. Distinguish between normal and abnormal physical findings (from physical assessment and vital signs assessment). Plan appropriate nursing care. Notify physician if needed and carries out appropriate interventions as ordered.
• Obtain patient history, pertinent family history, and documents in patient’s medical record.
• Utilize appropriate nursing personnel to assist in delivery of care when indicated (e.g., paraprofessionals).
• Transcribe or verify transcription of physician orders.
• Carry out prescribed physician orders and documents in patient medical records.
• Communicate pertinent patient data to physician as appropriate.
• Demonstrate proper preparation of patients for treatments and procedures.
• Assess and document patient response to medications administered and intervenes if desired response is not achieved.
• Instruct patient/family regarding prescribed medications/therapies and invasive/diagnostic procedures that must be accomplished.
• Conduct preoperative and postoperative visits. Discuss cardiac catheterization and diagnostic cardiac testing procedures with patients and inform them of what to expect during procedures. Consult with the physician performing the procedure and establishes priorities of care for each patient. Coordinate with other hospital units, which include recovery room, intensive care, and nursing units, on patients’ progress and any special equipment or supplies that will be needed for the patient post procedure.
• Properly apply cardiac monitor leads and 12 lead EKG machine, analyzes rhythm strips and notify physician of any abnormal results (e.g., dysrhythmias for patient situation).
• Participate in Discharge Planning as appropriate.
• Perform accurate documentation, both written and electronic, of all activity IAW requirements. Prepare 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.
• Perform the procedure recovery and discharge within established criteria.
• Participate and comply with quality and process improvement activities and events, including, but not limited to, post procedure follow ups, morbidity and mortality studies, and research studies to ensure compliance with national standards and guidelines.
• Serve and participate in committees, functions, and other meetings as directed.
• Provide relevant and timely information to these groups and assist with decision-making and process improvement. Participate in customer service.
• Complete orientation and competency verification programs IAW unit guidelines.
• Ensure a safe work environment, employee safe work habits and patient safety IAW regulatory agencies, infection control policies, and process improvement initiatives.
• Maintain national registries, to include the ability to interpret, analyze, edit, and input data into said registries.
• Coordinate cardiac referral process between VA, DoD, and outside facilities for care.
• Attend meetings to discuss VA sharing agreement, cardiology referrals, transfer process, coordination of patient care, etc.
• Perform EKGs and assists echo tech with bubble studies and contrast echoes as needed.
• Assist cardiologist with dobutamine or exercise stress tests within the cardiology laboratory.
• Shall provide patients with utmost care and attention. All patients shall be assured of their privacy and personal dignity.
• Will be required to travel to the Biloxi VA, approximately 10 miles round trip, for meetings or to help coordinate care for VA patients coming to the medical center for care. Frequency of travel should not exceed three times per month.
• 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.
• Shall possess, provide proof of, and maintain certification in BLS and ACLS/ALS.
• Shall require an active, full, and unrestricted nursing license within the jurisdiction in which the MTF is located. Assignment to a position not involving direct patient care within or outside an MTF does not eliminate the requirement for license or authorizing document.
• Shall continue to meet the minimum standards for Continuing Health Education (CHE) to remain current as prescribed in Air Force Instruction (AFI), Medical Service Officer Education.
Skills and Knowledge:
• Be able to interpret cardiac rhythms and their implications, intervene on emergent changes.
• 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 International Classification of Disease (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.