Referral Nurse I, Specialty

In collaboration with patients, families (as defined by the patient) and staff across all disciplines and departments is responsible for conducting triage assessments for patients by seeking advice and medical services and assists in determining predictable healthcare needs of patients in a community healthcare center setting.  

• Reviews all incoming internal and external specialty care services referrals. 
• Prioritize stat and overbook referral requests
• Make patient specialty care appointments
• Maintain and prioritize specialty care patient waitlist
• Assist in obtaining referral authorization from insurance carriers and relay such authorizations (or denials) to the patient and the provider. 
• Resolve pre-authorization, registration, or other referral-related issues prior to a patient's appointment. 
• Provides telephone and walk-in triage to patients seeking advice and medical services and advises and instructs patients on proper health care after assessing the urgency of symptoms or complaints as per protocols. 
• Provides direct nursing care to patients and distributes medications and treatments according to accepted standards of care. 
• Teaches and counsels patients and families concerning health assessment and care including prevention of disease, disability, hygiene and health maintenance. 
• Participates in the identification of patient needs for referral to resources that facilitate the continuity of care. 
• Accurately and completely reports and documents status, care rendered, response to care, provider orders, contacts with patient and/or other healthcare providers. 
• Accurately and completely performs patient follow-up activities including abnormal lab and diagnostics, referrals and call backs. 
• Participates in the orientation of new employees. 
• Participate in quality assurance activities and attends mandatory meetings. 
• Perform other duties as assigned.

PRIMARY ACCOUNTABILITIES

• Ensure that referral requests received from the PCP are addressed in a timely fashion. 
• Complete all direct and indirect care documentation in timely manner and ensure patient records are current and complete. 
• Maintain knowledge of current regulatory requirements for The Joint Commission and other state and federal programs. 
• Maintain all licensure and/or certification requirements. 
• Maintain confidentiality and adhere to all HIPAA guidelines and regulations. 
• Ensure all tasks and duties comply with all regulatory and accreditation standards including The Joint Commission and CommUnityCare Standard Operating Procedures and CommUnityCare Policies and Procedures. 
• Develop and maintain favorable internal relationships/partnerships with co-workers. 
• Ensure all actions, job performance, personal conduct and communications represent CommUnityCare in a highly professional manner at all times. 
• Uphold and ensure compliance and attention to all company policies and procedures as well as the overall mission and values of the organization. 

ESSENTIAL FUNCTIONS/ KEY COMPETENCIES

• Knowledge of all activities associated with the delivery of quality nursing practices and duties assigned to this role. 
• High level of skill at building relationships and providing excellent customer service. 
• High level of skill in managing multiple nursing activities at once. 
• Skill in medical record review and data abstraction. 
• Skill in use of computer software in order to enter data, review for accuracy, and create reports. 
• Strong attention to detail and accuracy. 
• Excellent verbal and written communication skills.

Education

• Graduation from an accredited school of nursing (BSN preferred).
• Current license to practice nursing in the State of Texas.
• Current healthcare provider Cardiopulmonary Resuscitation (CPR) course completion card.

Knowledge and Experience

• Minimum of 3 years’ experience in nursing.
• Demonstrated knowledge of medical record review process and reporting.
• Extensive knowledge in quality improvement/assurance processes, procedures and guidelines.
• Extensive knowledge of current evidence-based clinical treatment guidelines.

Physical/ Environmental

• Constant sitting, standing and walking.
• Occasional bending, reaching and lifting.
• A medium to high level of manual dexterity required.
• Frequent lifting of 25 pounds.