CRO - Health Referral Nurse

St. Joseph's/Candler; Savannah (GA); On-site; USD 52,000 - 76,000; Full time

Job summary

St. Joseph's/Candler Health System seeks a Health Referral Nurse to assist callers using nursing assessment and triage guidelines and to schedule appointments across the patient care continuum.

The role supports physician referrals, documents interactions, verifies insurance, and coordinates visits to specialists and ancillary services, collaborating with clinical staff to optimize outcomes.

Qualifications

• Competent nursing assessment and triage using standard guidelines.
• Ability to document calls and referrals accurately in clinical systems.
• Experience coordinating referrals, appointments and insurance verification.

Responsibilities

• Process calls, determine patient needs using nursing assessment tools.
• Document calls thoroughly for medical and statistical purposes.
• Identify and schedule referrals to specialists and services.
• Coordinate with labs, imaging and diabetes management as ordered.
• Ensure precertification and align referrals with insurer policies.
• Maintain quality via audits and professional conduct.

Skills

Nursing assessment

Telephone triage

Patient education

Documentation

Care coordination

Education

Associates in Nursing - Required

Tools

Meditech

eCW

Job description

• The Health Referral Nurse (HRN) is responsible for using nursing assessment and triage guidelines to assist callers and schedule appointments for patients assigned to the CRO. The HRN supports the system through responses to telephone inquiries involving the provision of appropriate health information and referrals to identified physicians, health system services and community resources. The HRN provides quality based individualized information that is patient-centered and effective for the patient’s needs. The HRN directly supports the physician referral process to include documentation, insurance verification, and scheduling patient visits to specialists and other ancillary services. The HRN collaborates with medical office coordinators, physicians, nursing, ancillary and other professional staff to define and achieve optimal provider referral outcomes for patients through responses to telephone inquiries and interactions. Utilizing clinical software and guideline/information databases, the HRN is responsible for assessing, triaging, and advising patients/callers who present with symptom-based problems or general health questions. This includes facilitating referrals to primary providers, specialists, healthcare facilities, and community resources as appropriate. Provides support to Health Referral Specialists (HRS's) through clinical monitoring, oversight and immediate availability for clinical issues that arise during coordination of patient medical communications.
• Education
• Associates in Nursing - Required
• Experience
• 2-3 Years Clinical Experience - Required
• Minimum of 3 years of recent clinical experience, 2 years of critical care experience preferred. Ability to manage situations related to family, visitors, patients of varied ages and needs, physicians and other hospital departments.
• License & Certification
• Professional License with State of Practice - Required
• Core Job Functions
• Calls are processed in a timely manner. Determines the customers’ needs utilizing nursing assessment tools. Symptom information is obtained and documented thoroughly and accurately in call center database. Demonstrates positive customer relationship skills with all patients/callers and thorough and concise documentation of all calls for medical, legal/statistical purposes with adherence to confidentiality agreements and policy and procedures.
• Uses the appropriate work flow to identify patients in Meditech discharged without a follow up appointment, obtains appointments and notifies patient with information regarding appointment within the timelines established by policy. Documents in Meditech as appropriate the status of each follow up appointment requested.
• Follows steps to process referrals, appointments to Specialists, PT, OT, Lab, Radiology, Diabetes Mg., and other referrals as ordered by the physician/provider within the eCW database system. Documents physician practice referral interactions within the appropriate database according to the standards for the physician/provider practice and the call center. Explains clinical nursing information pertaining to the aspects of the referral and provides patient with updates regarding referrals and appointments until the process is completed.
• Refers patients to correct laboratory, radiology center, hospital or specialist. Ensures precertification is obtained when needed prior to services being rendered. Follows referral process based upon insurance company's policies and procedures.
• Accepts responsibility to correct any pattern deficiency identified through quality audits, monitoring, or recordings. Demonstrates quality by documenting the application of the nursing process in a responsible, accountable and ethical manner. Strives to hit benchmarks as outlined in each key performance indicator. Maintains a positive and professional attitude.