Location: Miami, Florida
Facilitates hospital to hospital transfers while adhering to EMTALA guidelines and collaborates with physician, hospital staff, patient/family regarding higher level of care requests. Ensures all incoming and outgoing transfers are triaged through the Access Center to standardize process, ensure insurance authorization (when applicable), and secure accepting physician who will provide the medical care that meets the patient's needs. Document all communication, demographic information, clinical information, financial information, insurance information, and outcome determination.
Job Specific Duties
- Establishes and maintains trusting and professional relationships with referring parties by providing excellent customer service.
- Engages with referring parties in a professional and collaborative manner to understand referring parties' needs, being aware that many referring parties call to transfer clients to other programs or seek additional help for clients in need of multiple services.
- Completes daily assignments in the Transfer Center.
- Coordinates transfers from external facilities from ED to ED or Inpatient Level of Care to Inpatient Level of care.
- Coordinates transfers from NCH to other external acute care providers when services or care cannot be provided at NCH.
- Secures clinical information for all transfer requests from external facilities to ensure that we have the capacity and capability of meeting the patient's medical care needs.
- Collaborates with bed control and patient access to ensure that the patient is registered appropriately and there is a bed assignment before transfer occurs.
- Follows EMTALA guidelines and hospital policies and procedures for all transfers to avoid any regulatory, compliance or legal issues.
- Collaborates with Patient Access to verify insurance benefits and secure authorization for transfer as appropriate.
- Utilizes knowledge of InterQual and/or MCG criteria to determine appropriate level of care for transfer in order to place the patient in the correct patient status.
- Maintains strict documentation on all transfer requests including patient demographics, reason for transfer, referring facility, referring physician, insurance information, and outcome determination.
- Collaborates with Physicians and Nurses at both the transferring and receiving facility to facilitate a telephonic hand-off report prior to the transfer.
- Secures authorization from payer for the transfer (as warranted).
- Provides hand-off, verbally and in writing, for the incoming Access Center RN at change of shift.
- Works closely with the Access Center Coordinator regarding all administrative duties (i.e., faxing documents, calling to confirm transfer acceptance, etc.).
Minimum Job Requirements
- RN Licensure within the State of Florida or Multi-State Enhanced Nursing License Compact (eNLC) - maintain active and in good standing throughout employment
- 1-3 years of nursing experience in an acute care healthcare environment
Knowledge, Skills, and Abilities
- BSN Degree preferred
- Pediatric nursing experience in an acute care setting or experience in case management/transfer center preferred
- Experience in application of InterQual or MCG to determine level of care preferred
- Excellent organizational and time management skills necessary to process transfer requests expeditiously
- Sound clinical knowledge necessary to facilitate case presentation to the ED or accepting physician
- Knowledge of insurance plans to determine eligibility for services being requested
- Knowledge of EMTALA law to ensure compliance with legal standards
- Ability to coordinate incoming and outgoing transfers by ensuring that the appropriate clinical documentation is submitted, reviewed and the outcome determination documented
- Ability to establish and maintain trusting and professional relationships with referring parties by providing excellent customer service
- Awareness of all facility programs, eligibility requirements, and contact information to reduce transfer delays
- Ability to document clearly and accurately for record-keeping purposes and reporting
- Knowledge of payer authorization processes to streamline authorizations requested for transfers (as warranted)
- Able to obtain and effectively use information, including the ability to identify the information needed, seek the information from a variety of sources, and skillfully extract and report the information for business benefit
- Able to absorb complex technical information and communicate effectively to both technical and non-technical audiences
- Strong interpersonal and teamwork skills
- Ability to communicate information clearly and effectively both verbally and in writing at all levels of seniority, both formally and informally
- Proficient in the creation and delivery of presentations to convey information
Nursing - Clinical
Primary Location :
Florida-Miami-Nicklaus Children's Hospital - Main Hospital Campus