Primary City/State:

Mesa, Arizona

Department Name:

Banner Staffing Services-AZ

Work Shift:

Evening

Job Category:

Clinical Care

POSITION SUMMARY
This position manages incoming member/patient calls to evaluate call purpose and acuity utilizing established protocols and nursing assessment. Recommends appropriate care disposition and follows up as necessary to promote positive outcomes for member/patient. This position also utilizes protocols to assess the situation and provides treatment recommendations, options and ultimate care resolution. This includes reviewing caller’s relevant health care information, as well as documenting the purpose, information and resultant disposition of the call. This position may provide education to the public or other health professionals and participate in continuous quality improvement projects. May also facilitate appropriate referrals to physicians, services, and facilities, and/or directs individuals to other departments or services that may meet the needs and treatment recommendations.

CORE FUNCTIONS
1. Evaluates member/patient call and needs following established protocols. Utilizes databases and best practice evidence available, as well as clinical judgment to determine purpose of the call. This also includes assessing the member’s status to provide appropriate direction toward resolution whether triaged to another source or treatment recommended.

2. Utilizes multiple databases and electronic health systems (EHR) to research member history to provide appropriate coordinated care. Determines the acuity of situation/needs and triage callers to the appropriate level of care or call resolution.

3. Effectively accesses symptom-based guidelines, as well as documents all calls for medical/legal purposes using appropriate tools. Documents assessment, planning, implementation and evaluation in a timely manner to ensure compliance with established policies and procedures. Documentation reflects objective/subjective data, nursing interventions and patients response and disposition plan.

4. Actively participates in quality assurance and improvement processes to deliver excellent customer service to callers.

5. Considers the patient/member’s physical, cultural, psychosocial, and spiritual and age specific needs when planning care or direction toward treatment or call resolution.

6. Monitors member needs and proactively connects members with the appropriate services or contacts other departments or locations to assist with coordination of care of the patient.

7. Provides direction and supervision to licensed and non-licensed personnel in the activities necessary to provide quality care and services. Customers are external community callers and healthcare providers as well as internal employees and physicians. Interacts with all levels of staff in a variety of departments, physicians, patients, families and external contacts, such as employees of other health care institutions, community providers and agencies, concerning the health care of the patient. Interacts with other health care providers in numerous settings in order to report and ask for or clarify information. Synthesizes and prioritizes data from multiple sources to provide support for the human response of the patient and family to changes in health status.

MINIMUM QUALIFICATIONS

Must possess knowledge as normally obtained through the completion of a Bachelor's degree in nursing or related field.

Must possess a current, valid RN license in state of practice, temporary RN license in state of practice, or compact RN licensure for current state of practice.

Current BLS certification is required for state of practice. BLS certification is not required for remote workers or for team members working in the Insurance Division.

Additional certification or continuing education may be required based on area of practice.

Requires a proficiency level typically achieved with five years clinical experience. Requires excellent organizational skills and clinical knowledge regarding specialty care services, as well as care coordination of services, legal and financial aspects of diagnostic services and health services in specialty area. Must possess ability to make autonomous decisions utilizing excellent clinical judgment. Must possess highly effective interpersonal and communication skills. Must understand the principles of quality customer service. Requires effective communication and writing skills, good time management skills and knowledge of word processing and database software applications. Requires the ability to teach both clinical and non-clinical personnel regarding care and diagnostics services. Also requires a good understanding of process improvement.

PREFERRED QUALIFICATIONS

Bachelor’s in nursing and/or recent telephone triage experience strongly preferred. Previous emergency nursing, pediatric nursing, maternal/child health, ambulatory, home health or critical care experience preferred. Bilingual ability a plus.

Additional related education and/or experience preferred.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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