Job description

Description: Summary:
The Triage Nurse ensures prompt identification of patient with high-risk conditions and provides direction for evaluation of the patient’s situation to estimate severity of illness and/or injury. Triage Nurse ensures achievement of maximum medical and disability improvement through early, proactive treatment referral or intervention. These activities emphasize quality care through coordination of cost-effective appropriate treatment. These objectives are obtained by communication with the primary care physician, the injured worker, the employer, claims adjustor and all other parties involved in facilitating the best possible outcome for the given claim. The Triage Nurse is aware the claims adjustor is ultimately responsible and accountable for the outcome of these claims and no intervention is undertaken without their authority and direction. The Triage Nurse is seen as the patient’s advocate and as the representative of the insured and must be able to satisfy the needs of all concerned while being objective and effective
Essential Duties and Responsibilities:

• Talks directly to employees on the telephone and then directs them to emergency rooms (ERs) or urgent care centers or to see their physician during office hours or provides home health advice
• Initial contacts (employee, employer, Primary Care Physician) and documentation are to be completed on all files referred within 24 hours (when applicable).
• Perform short evaluations of the patient situation to estimate severity of illness and/or injury including learning about chief complaints and mental status information.
• The Medical Case Management nurse will address all medical issues and coordinate as needed to insure optimum outcome with timely and appropriate medical care.
• Determines urgency of seeing the patient based on brief assessment and on familiarity with a patient’s condition and history. May use computerized medical information database, which uses algorithms that closely imitate physician logic and thought patterns, as guide. Confers with Tele Medicine physician as needed.
• Sends those with high-risk chief complaints such as chest pain, abdominal pain, severe headaches, severe pain, bleeding and possible fractures to ER immediately or arranges for ambulance. May provide appropriate home health advice to those patients who do not need to go directly to the ER
• Coordinate appointments for patients who do not need to go to ER but need to see a physician. Coordinate through MPN and Specialty Network for directions of care
• Provide self-care information when appropriate and follow up the next day if needed
• Document all injury information and medical history as needed
• Provide initial return to work coaching as needed
• Will identify the medical diagnosis and treatment plan; validate diagnosis and corresponding algorithms of care.
• Complete and distribute injury report to client contacts/create claim
• Provide ad hoc clinical resource to CCSF/SFMTA
• Available to triage calls after hours
• Will direct and maximize the utilization of PPO/MPN networks.
• May be required to direct non-clinical tasks to non-clinical staff
• Participate in a quality management program meeting and project for at least 5% of average hours worked.
• Maintain awareness of potential compromise in a patient’s safety for each review. Refer to proper authority.
• Uses plain language to communicate (written and verbal) with injured workers, claims examiners, and clients.

Requirements: Supervisory Responsibilities:
May be required to direct ancillary non-licensed personnel
Competency:
To perform the job successfully, an individual should demonstrate the following competencies:

• Must be self-motivated with the ability to multi task and adapt to changing work priorities
• Must have strong organizational skills with attention to details
• Must have strong time management skills
• Must be able to work well with a variety of co-workers, clients, vendors, and others
• Must be able to follow directions

Qualification Requirements:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience:

• Current and valid California RN
• Minimum of 3 years clinical experience
• Minimum of 1 year of telephone triage experience, preferably in medical practice setting.
• Experience in one of the following: Med surge (Pre-post op care), Acute care (CCU), or a step down unit, Home Health nursing, or Workers’ Compensation

Job Type: Full-time

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