Population Health Management Triage Nurse III, Bakersfield, CA

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Population Health Management Triage Nurse III

Kern Family Health Care, Bakersfield, California, United States of America Req #2596

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).

KHS reasonably expects to pay starting compensation for the full-time position of Population Health Management Triage Nurse III, in the range of $48.36 - $62.98 hourly.

Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

Primary Purpose

Under general supervision, the PHM Triage Nurse receives incoming referrals, identifies levels of complexity, prioritizes urgent referrals, and appropriately assigns referrals to staff. The PHM Triage Nurse acts as liaisons and utilizes available resources across a continuum of care and in collaboration with members, caregivers, medical home providers and ancillary health care providers. The PHM Triage Nurse assists in the coordination of the activities of a specialize services or projects; assists the Supervisor, Manager and Director in the administration of nursing activities; assists in the training and development of assigned staff and providers; and performs other related work as required.

Class Characteristics

Incumbents in this position are fully competent in all essential areas of case management and are expected to use an advanced level of judgment in the discharge of their duties. Case Managers work independently under general direction. This position involves frequent communication with members, caregivers, medical providers, and KHS staff telephonically, electronically and potentially in-person.

Supervises: No

Essential Functions

Care Management and Frequent Utilizers Referrals

• Assumes responsibility and accountability for assessing, planning, implementing, and evaluating referrals of patients to determine patient acuity including medical and psychosocial needs.
• Triages incoming referrals (low, moderate and high) to ensure patients with higher level of care and/or urgent authorization requests are addressed accordingly.
• Reviews referrals to determine appropriateness and completeness of information needed for care management.
• Assigns appropriate referrals to staff in a timely manner.
• Takes referrals that can be resolved in 2-4 phone calls with patients. These assignments are not assigned to staff.
• Document all care plan notes in accordance with professional standards in a thorough and timely manner.
• Provides consultations to LVNs and CMAs with patient care coordination
• Acts as a patient advocate and educator to assure that the patient has the knowledge to care for his/her condition and patient is educated and empowered to make healthy choices.
• Serves as a resource for patients.
• Contacts referring parties for additional information / documentations before assigning to staff.
• Consults with healthcare providers, discharge planners, and outside agencies continued care/treatment or hospitalization or referral to support services or placement.
• Participates in Interdisciplinary Care Team (ICT).
• May need to facilitate transportation for patients.
• Works in collaboration with Business Intelligence in developing and maintaining ongoing tracking system to monitor incoming referrals.
• Collects, compares, and analyzes data; identifies trends; and addresses gaps in services; maintains records and prepares reports.
• Precepts new staff to the Triage and IVR Team.
• Participates and acts as a resource to the Fraud Waste & Abuse Committee
• Resource to the Grievance Committee for Complex Members.
• Perform other related duties and special projects as assigned.

IVR Triage Calls

• Coordinates appropriate responses to inbound calls and emails from patients.
• Triages communication from various channels.
• Evaluates and assesses patient’s needs based on objective and subjective patient information.
• Answers questions/concerns from patients over-the-phone.
• There may be times that the nurse may provide consultations with patients needing care. For instance, providing medical advice to persons who have minor/common health problems.
• Evaluate the intensity of a patient’s illness quickly before proposing a suitable degree of care centered on all available information.
• Refers or links patients with community resources/services, experts or other organizations
• Accurately documents patient’s questions/concerns, advice provided and patient/caller response in patient and department records.
• Develop a care plan that includes necessary follow-up measures (if needed).

REQUIREMENTS:

Core Competencies/Knowledge & Skill Requirement

• Lead by example to support a positive work environment that values patient advocacy, respectful listening, diverse expression of opinion and constructive conflict resolution;
• Adheres to KHS’s Code of Ethics and Business Conduct and all company policies; e.g., confidentiality, attendance, safety/security, use of equipment and technology, appearance and demeanor;
• Knowledge of Population Health Management, social determinants of health and health equity.
• Represent KHS in a positive manner to all members, caregivers, staff and external stakeholders;
• Demonstrate commitment to continuous improvement;
• Strong knowledge of acute chronic care nursing principles, methods and common treatments;
• Strong knowledge of common human diseases and usual and customary methods of treatments;
• Demonstrated knowledge of medical terminology;
• Ability to effectively evaluate medical records to determine appropriateness and necessity of care;
• Demonstrated knowledge of health care delivery systems;
• Very strong interpersonal skills, including the ability to establish and maintain effective working relationships with individual at all levels both inside and outside of KHS;
• Ability to use tact and diplomacy to diffuse emotional situations;
• Effective oral and written communication skills, including the ability to effectively explain complex information and document according to standards.
• Intermediate skills in Word and Excel with basic ability to enter data into and navigate through a database.
• Demonstrated ability to respect and maintain the confidentiality of all sensitive documents, records, discussions and other information generated in connection with activities conducted in, or related to, patient healthcare, KHS business or employee information and make no disclosure of such information except as required in the conduct of business;
• Demonstrated ability to commit to and facilitate an atmosphere of collaboration and team work;
• Self-directed, with proven ability to work independently with minimum supervision;
• Demonstrated ability to multi-task in an interrupt-driven environment and complete assignments on a timely basis;
• Strong attention to detail; work accurately and at a reasonable rate of speed;
• Compliant with KHS policies and procedures; performs the job safely and with respect to others, to property, and to individual safety.

EMPLOYMENT STANDARDS

Education:

• Registered Nurse with an active, current, unrestricted California license
• Minimum of three (3) years full-time clinical experience in acute care, community health setting, public health nursing or chronic disease management required; with a minimum of two (2) years at KHS or a Knox-Keene managed care health plan.
• Experience working with patients and caregivers regarding self-care and disease management required;
• Experience working in case management or care coordination is a plus;
• Knowledge of Kern County Community resources for seniors and people with disabilities is a plus;
• Bachelor’s Degree in Nursing, Health Administration, or related healthcare field preferred.

OTHER REQUIREMENTS:

• Bilingual (English/Spanish) preferred

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.

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