Delivers general nursing care utilizing a systematic approach to nursing practice incorporating: assessment, planning, implementation, and evaluation; thus providing continuing health care to individuals, families, and communities. Responsible for conducting timely responses to all requests for ancillary services required to meet medical necessity criteria to include reviewing pre-certification and authorization criteria for outpatient services. Work closely with physicians to ensure proper criteria met for authorization for services.
1. Assesses patient care requirements, incorporating interdisciplinary needs along with the patient’s emotional and physical state.
2. Maintains safe, direct patient care which addresses the patient’s current clinical and emotional status.
3. Evaluates and documents the patient's response to nursing interventions, reflecting changes made to the plan of care.
4. Actively participates in the discharge planning process.
5. Performs competencies (including age-specific competency) as identified through the departmental competency program.
6. Implements care and services that recognize age-specific needs and issues for customers served.
7. Formulates and documents an individual teaching plan for each patient, based upon assessment of patient’s, family’s, and significant other’s teaching needs.
8. Demonstrates effective informal patient teaching skills, using one-on-one interventions and written National Jewish supportive material.
9. Participates in team-based Quality Improvement program and utilizes results to improve patient care.
10. Demonstrates professional demeanor and positive interpersonal relations in dealing with patients, families, significant others, and other members of the multidisciplinary team.
11. Demonstrates the ability to manage a typical patient assessment by: setting appropriate priorities, organizing activities, utilizing available resources, and exhibiting flexibility in accepting assignments.
12. Evaluates clinical information documented by providers against plan review criteria.
13. Utilizes professional judgment to determine if additional information is required to ensure proper criteria is met for authorization.
14. May recommend and facilitate completion of peer reviews by obtaining and delivering medical records and diagnostic films as well as conferring with physicians both in person and on the phone.
15. Utilizing experience and medical resources interprets medical records and test results and provides assessment accordingly. Utilizes nursing process and utilization management standards of practice guidelines.
16. Communicates with physicians at regular intervals and develops an effective working relationship.
17. Works with manager and providers to ensure complete medical information is available to allow utilization management decision to be made with standards for decision making.
18. Performs all other duties as assigned.
1. Performs, as directed, safety compliance and uses Personal Protective Equipment (PPE), as needed.
2. Participates in Quality Assessment (QA) and Quality Improvement (QI) programs, as directed.
3. Ensures compliance with The Joint Commission and all other Federal, State and Regulatory Agencies.
4. Responds promptly and sincerely to customer’s needs, requests and concerns via all communication forms using easily understood language and refraining from using inappropriate language and non-verbal gestures.
5. Maintains positive working relationships as a team player through problem solving issues, speaking positively about others, listening attentively and observing the Patient Bill of Rights and Confidentiality.
6. Increases customer service knowledge, skill and ability by participating in department and institution-wide specific programs.
7. Incorporates National Jewish’s identity (Science Transforming Life®) into daily functions. Speaks positively about the institution, provides customers with prompt service, maintains a clean and safe working environment, dresses appropriately based upon National Jewish safety standards, and departmental policies and wears an ID badge visibly.
Knowledge and Skills
Strong clinical background with experience in respiratory disease. Ability to work independently under general instructions and as part of a team. Excellent communication, customer service and telephone skills. Excellent time management skills, including the ability to manage priorities and complete assignments with designated time frames. Working knowledge of CMS Guidelines. Experience with third party payer billing regulations, reimbursement requirements, precertification, utilization management, and/or coding practices is highly desirable. Background in Precertification, Case Management and/or Utilization Management a plus.
Bachelor degree in Nursing or Graduation from an Accredited School of Nursing required.
Certification and Licensure
Current Colorado RN license required. CPR/BLS required.
A minimum of two (2) years of recent and related RN experience is required. Different patient care units may require additional experience.
- or - Any equivalent combination of Education and/or Experience
Position is in a clinical nursing environment. Frequent requirements may include: reading and comprehending medical literature, including interpretation of disease processes, medical charts, nursing/medical journals and books, medication instructions and physician notes and instructions. Also includes calculations of adult and/or pediatric medication dosages, IV administration, review of vital signs, spirometry, percentiles and interpretation of graphs and lab values. Communication includes ability to provide comprehensive and accurate nursing progress notes, communication with interdisciplinary team as well as with differing ages and levels of maturity/understanding of patient and family, committee reports, discharge plans for patients, memos to staff members, taking and recording telephone messages. Manual dexterity is needed to write notes while holding a chart, manipulating and operating equipment such as non-invasive blood pressure monitoring device, IV pump, oximeter, Jaeger for spirometry testing. Frequently has the need to assist a patient by moving or lifting. Also involves pushing wheelchairs, opening doors and cabinets, reaching for medications or objects. Physical Demands may include the ability to lift up to 25 pounds. Incumbent must be able to bend in order to retrieve a fallen object for a patient. Mental demands include, concentration, alertness, memory, judgment, ability to analyze, ability to apply logical thinking to define problems, establish facts and draw valid conclusions. Occasional requirements may include: sitting while completing paperwork, kneeling, and squatting. Incumbent may be scheduled to work an alternate schedule to accommodate essential business needs routine travel by foot or automobile to alternate work/meeting locations, possibly during inclement weather.
Inside environmental conditions may include: Handling syringes and needles and have the potential for coming into contact with bloodborne pathogens. Has frequent exposure to infectious diseases. Occasionally, may encounter radiation from portable radiology procedures. May come into contact with various fumes/odors. May come into contact with toxic waste while providing chemotherapy. Also may encounter contaminated biological waste from infectious patients. Personal Protective Equipment (PPE) will be provided to each employee when needed as determined by policy. Utilization of PPE is mandatory. Estimated 1700 employees in worksite.