Job Brief: Emergency Care Management (ECM) Hub LPN
The position is staffed by a Licensed Practical Nurse who utilizes the nursing process and clinical skills to prioritize/triage provider calls regarding repatriation/intrapatriation of members, adhering to organizational policies, procedures, and guidelines. The LPN will support the ECM Hub MD in repatriating members from noncore Emergency Rooms or inpatient/observation status within the Kaiser Permanente Georgia Region and assist with transfers/admissions of members. The LPN may also assist with coordinating transfers back into the service area of Kaiser members with acute illnesses or injuries sustained while traveling outside of the Georgia Region as indicated by the medical condition of the member.
The position will be responsible for: 1) locating members at non-core facilities, including identification of ER or IP room number; verifying attending MD name and phone number, 2) verifying member eligibility, 3) obtaining and communicating pertinent clinical information to the ECM Hub MD, 4) assisting MD in obtaining hospital bed, vital signs, arranging ambulance transport, other coordination as needed, 5) leading and guiding Support Staff when needed, 6) initiating follow-up appointments or other coordination of care, as directed by the ECM Hub MD, 7) facilitating urgent and non-emergency same day ambulance transports for all KP members as appropriate.
Summary:
The Southeast Permanente Medical Group (TSPMG) is one of Georgia’s largest independent, physician-owned, multi-specialty medical groups. More than 700 physicians and 300 associate practitioners work together in a unique integrated care model to provide high-quality care to Kaiser Permanente members. Our focus is on long-term health, effective prevention, diagnosis and treatment of disease. Care is delivered across 40+ specialties at 26 medical offices featuring state-of-the-art equipment, labs, imaging services, and pharmacies. We also provide surgical services and around-the-clock care at some of the area’s top hospitals. We invite applications for an intern in Clinical & Health Systems based at our regional office.
About the area:
Atlanta, our home for more than 40 years, is a thriving metropolis that blends southern charm with modern art, music, and culture….where Southern charm meets big-city energy. From its iconic skyline and rich civil rights history to a buzzing food scene and world-class arts, Atlanta is a city that never stops moving. Home to Fortune 500 companies, a booming tech and film industry, and a strong academic presence, Atlanta offers exceptional professional opportunities. With a major international airport and a culture that values balance, Atlanta is a smart move for professionals ready to grow and thrive.
What You Can Expect:
Receives incoming calls via the ECM hub queue line from KP and outside providers, gathers initial pertinent information including clinical information, verifies benefits & eligibility, and prioritizes call
Opens HealthConnect ECM Hub Encounter for each call received with accurate documentation including name of responsible practitioner, best contact phone number, patient location, payer status, and any pertinent clinical information. Screen HealthConnect In-basket Referral Request folder for members in noncore facilities. Locate members by facility, obtain location/room number, identify attending MD and contact information, verify member eligibility & benefits. Contact ECM Hub MD with member information.
Daily follow up calls to obtain ongoing clinical information for members remaining inpatient at noncore hospitals. Links ECM Hub MD to responsible practitioner by phone.
Routes encounters to the appropriate Quality Resource Management department pool for admission authorization/concurrent review or for potential denial
Reviews same day requests for non-emergent ambulance transport utilizing knowledge of approved origin/destination and medical necessity criteria. Follows documented processes for approval and denial.
Provides verbal communication to members/designated family member or representative, in accordance with policy and procedure with respect to potential transfers.
Achieves and maintains an understanding of relevant state and federal regulations, criteria, and documentation requirements and laws that affect managed care, home health and case/utilization management.
Facilitate transfer of members to inpatient and ED beds which includes obtaining a hospital bed, ensuring an accepting MD is obtained, arranging ambulance transport when required, ensuring appropriate clinical information (imaging results on disc, etc.) accompanies member.
Perform other duties as assigned which include but are not limited to:
Monitoring Cortext, Transportation and Emory Transfer Center Teams chats
Arrange follow-up appointments as needed
Screen in-basket messages in HealthConnect; follow-up as needed
Minimum Requirements:
Unrestricted current LPN licensure in the state of Georgia required.
Valid Georgia driver’s license
Two (2) years of experience in clinical setting
Working knowledge of all federal, state, local and regulatory requirements
Functional knowledge of computers
Functional knowledge of computer applications
Three (3) years of clinical nursing preferably in acute care setting
One (1) year of experience with managed health care delivery including Medicare
TSPMG Administrative Staff:
Are committed to supporting our practice of providing care of the highest quality
Provide excellence in service
Are honest and ethical and show Integrity in their actions
Demonstrate accountability for their performance
Dedicated to the success of the Team
We Provide You (may vary based on employment status):
Generous paid time off
Many additional benefits that support your work/life balance
TSPMG is an equal opportunity employer. All applicants will be considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran or disability status. We maintain a drug free workplace and perform pre-employment substance abuse testing and background checks.