Job Description

JOB TITLE: Telephone Nurse Advisor

SUPERSEDES: 05/07, 04/13, 01/19, 04/20, 04/21, 08/21

FLSA: Non-Exempt

JOB CODE: 9208

ISSUED: 05/2007

REVISED: 04/2024

BASIC FUNCTION AND RESPONSIBILITY

The Telephone Nurse Advisor practices care via the telephone by utilizing organizationally approved telephone nursing guidelines and protocols for scheduling ancillary and surgery procedures, performing patient interviews and completing health assessments, obtaining pre-certification, and patient discharge follow-up calls.

ESSENTIAL FUNCTIONS

Determines appropriate clinical details to enter/extract data for scheduling, rescheduling, and canceling exams or surgical procedures. Enters notes for pre-certification and follow-up, including patient discharge surveys by utilizing electronic and telephonic systems. Enters patient and provider data into an electronic system. Maintains physician privilege list and payer requirements.

Maintains and enhances an up-to-date level of knowledge regarding professional telephone nursing practices. Proactively provides service recovery as needed. Utilizes message center to communicate and resolve scheduling issues with providers/patients.

Processes incoming and outgoing patient and clinical staff calls for scheduling, rescheduling, and cancellations. Conducts phone interviews for pre-procedure screening purposes, follows up on patient discharge, and assesses real or potential acute chronic health problems. Utilizes customer service-friendly skills and stellar phone etiquette.

Processes verbal and written physician, department, and payer requests by obtaining clinical data for scheduling and certifying services. Acts as a liaison for provider/patient as necessary. Maintains a low abandonment rate and wait time-based on call volume. Provides timely follow-up as required. Maintains established productivity standards.

Provides information to providers and patients regarding prescribed procedures, medications, and therapies, by utilizing appropriate physician consultation. Understands and explains medical terminology and procedures. Identifies patient, family, physician, organization, and community resources for patients and physician consults and referrals.

Records, communicates, and documents data from phone calls to ensure a high quality of care, effective continuity of care, and prudent risk management for the organization.

Validates payer source and obtains pre-certification and prior authorization by obtaining clinical data and reviewing InterQual criteria and Medicare guidelines, and, as necessary, recommends appropriate level of care.

9208h-TelephoneNurseAdvisor04/23/2024

May complete unit/department-specific duties as outlined in department documents.

KNOWLEDGE, SKILLS AND ABILITIES

Typing ability of 30 words per minute and competency in personal computer use.

SUPERVISION RECEIVED

Direction is received from a Nursing Supervisor or Manager.

SUPERVISION EXERCISED

None

REQUIRED QUALIFICATIONS

Missouri Board of Nursing RN or Nurse Licensure Compact multi-state RN. When primary state of residency changes, compact state RNs must apply under new state of residency within thirty (30) days.

One (1) year of of RN experience.

PREFERRED QUALIFICATIONS

Three (3) years of RN experience.

Additional license/certification requirements as determined by the hiring department.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met with or without reasonable accommodation. The performance of these physical demands is an essential function of the job. The employee may be required ambulate, remain in a stationary position and position self to reach and/or move objects above the shoulders and below the knees. The employee may be required to move objects up to 10 lbs.

PERFORMANCE EXPECTATIONS

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job; however, completion of these duties is a measure of successful performance. Employees of this job classification are subject to performance reviews. Basic function, responsibilities and characteristics duties may change at any time with or without notice.

SAFETY SENSITIVE STATUS

This position is considered safety sensitive.

This document is a general description of typical job duties, responsibilities and qualifications of employees holding the associated job title. Additional duties, specific qualifications and work emphasis may vary between individual positions.