Miami, FL Full-Time JW-Emergency Medical

Summary

Physician Assistant is professional technical work which relieves physicians of many essential and time consuming tasks. The incumbent interviews patients, takes medical histories, performs physical examinations, orders laboratory tests, makes diagnosis, prescribes appropriate treatment, provides postoperative care and assists during complicated medical procedures. Work is performed under the direct supervision of a physician.

Responsibilities

Identifies patients to be case managed using MediFax, DDE or other system applying InterQual, M&R, First Health or other specific criteria related to diagnosis, clinical condition, cost and/or payor. Follows unit specific policies and procedures. Participates in daily rapid rounds / clinical rounds on inpatient population. Assesses / provides patient age specific needs and evaluates effectiveness of care. Prioritizes/plans care based on knowledge of growth and development of patients served. Coordinates scheduling of pre-admission work-up / admission work up /elective/emergency procedures/surgery prior to surgical or procedure date. Assesses/plans for patient care requirements throughout the continuum of care for specific diagnoses, procedures, DRGs and/or populations according to state and federal guidelines. Assesses complex patient care needs/situations/acuity levels obtaining significant data from assessments (physical/functional, mental, psychosocial, environmental, family support, spiritual, cultural, financial, legal). Participates in care planning including discharge planning and determines appropriate interventions/referrals. Assists with coordination of discharge follow-up as needed. Assesses patient needs to ensure services are appropriate to the condition/procedure/level of care and reports significant findings/seeks corrective action. Facilitates resolution of conflicts and problem solving. Identifies ethical dilemmas such as conflict of interest, and seeks appropriate resources/consultation to formulate decisions/solutions. Coordinates patient care throughout an episodic/continuous course of care for a specific DRG/diagnosis/procedure/population using InterQual, M&R, First Health or other specific criteria and evidence based guidelines. Plans and coordinates access to care at the next level in the care continuum. Facilitates continuity of care by organizing/conducting/participating in patient care conferences. Facilitates the delivery of services in a timely and cost-effective manner using effective negotiating skills. Evaluates/monitors the level of care along the continuum of care (e.g. effectiveness of meds, treatments, pain status, plan) and individualizes the plan of care including teaching/discharge planning. Assists patients/family to appropriately self-direct care, self-advocate, and make informed health care decisions to the degree possible in the ongoing plan of care. Assesses patient compliance with prescribed treatment regimen and facilitates compliance as needed. Obtains authorizations / pre-certifications and continued stay authorizations as required. Demonstrates expertise with the KeyPro/First Health web based review procedures. Refers problem cases/denials to the Clinical Service Coordinator and appropriate medical/administrative team members. Applies the appeals management process as necessary. Monitors patient progress throughout the episode of care for LOS, cost and variances, based on acuity and regulatory/legislative requirements (AHCA, DCF, CMS, JCAHO, CARF, HRSA, INS, US Armed Forces). Identifies practice issues based on evidence based guideline trends (clinical pathways/medical criteria/disease management protocols), and intervenes as necessary with appropriate service management. Documents case management activities (i.e. HIS managed care notes, HBOC, PRO internet websites, Esphere, Excel/Access spreadsheets, and abstracts). Participates in the development of disease management programs as appropriate. Coordinates and assists in the internal and external transfer of patients to other acute care, SNF, rehabilitation, psychiatric, residential, forensic, ALF, and/or other facilities. Develops an initial discharge plan based on assessment and cooperation with the patient, physician and other team members/agencies (i.e.. SW, PT, OT, RT). Coordinates and arranges for, consults with & refers to social worker or other health team member when appropriate. Coordinates, arranges, consults and refers to social worker or other health team members for appropriate services post-discharge as indicated (i.e. ACLF, SNF, REHAB, HHC, DME, community case management, transportation, financial assistance, emotional support, medication, supplies etc.). Identifies system, practice and patient issues (including quality of care and quality of life outcomes) and collaborates in their resolution/improvement with appropriate internal (JHS-Risk Management, Medical Records, Patient Finance, Medical Services, etc.) and/or external services or agencies (managed care organizations, AHCA, DCF, CMS, JCAHO, CARF, HRSA, INS, US Armed Forces, etc.). Recommends/assists in the implementation of strategies (i.e.. evidence based practice guidelines) to control LOS and/or resource utilization within the case managed population. Identifies the achievement of goals that are a direct result of case manager interventions. Maximizes patient outcomes through incorporating community-based and non-benefit related services whenever possible. Prepares and distributes reports as required: utilization management reports, productivity, denial management, annual, LOS, clinical pathway, performance improvement, National Report of Quality Indicators, transfer, high utilizer reports, etc. Communicates team recommendations regarding practice and/or systems changes based on report. Identifies all members of the health care team appropriate for the development of evidence based guidelines. Performs data analysis for DRGs, diagnoses, procedures, and/or populations using data systems including HCIA/Solucient reports, WinStat, ClinAff, Esphere, etc. Facilitates and coordinates evidence based guideline development/revision activities (clinical pathways/medical criteria sets - InterQual, M&R, First Health/disease management protocols) incorporating research findings. Critically evaluates the activities and practice patterns of evidence based guidelines (clinical pathways/medical criteria sets/disease management protocols) utilizing case management resources and clinical expertise. Provides feedback related to evidence based guideline activities (clinical pathways/medical criteria sets/disease management protocols) to CRM department and related departments/health team members. Participates in outcome analysis as related to clinical services, functional status and financial resources. Evaluates/communicates outcome analysis to relevant administrative source. Utilizes an integrated system approach to case management across the continuum of care. Articulates information pertinent to clinical condition, LOS, outcomes, resource utilization, discharge planning, etc. at team meetings/presentations and to administration, medical director and physician advisor. Demonstrates knowledge of the legal scope of practice of health care members/providers: JCAHO, AHCA, DCF, CMS, INS, law enforcement, Baker Act, etc. Acts in accordance with legal principles of patient confidentiality, consent health care proxies, advanced medical directives, and abuse/neglect in compliance with HIPPA and corporate compliance guidelines. Plans and coordinates multidisciplinary weekly/month/quarterly team meetings with internal and external participants/agencies. Identifies the need for and participates in research projects as related to case management/disease management activities. Applies systematic use of research methods to evaluate clinical resource management practice and studies the effectiveness of such interventions. Incorporates patient/family learning needs/readiness to learn, as well as, cultural barriers and physical/cognitive limitations in the development/implementation of evidence based criteria tools. Informs patient/family/proxy/guardian of healthcare benefits/coverage as needed. Demonstrates knowledge of/acts as a patient advocate regarding financial class and payor groups including healthcare benefits and coverage. Collaborates with Patient Financial Services regarding appropriate financial class and payor group. Evaluates the result of educational activities on patient outcomes including LOS and resource utilization. Demonstrates behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise). Performs other related job duties as assigned.

Experience

Generally requires 1 to 3 years of related experience.

Education

Advanced degree in specialty is required.

Skill

Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines. Ability to communicate effectively in both oral and written form. Ability to handle difficult and stressful situations with professional composure. Ability to understand and follow instructions. Ability to exercise sound and independent judgment Knowledge and skill in use of job appropriate technology and software applications.

Credentials

Valid Florida Physician Assistant license and DEA board certification are required. Other specialty certifications related to specialty are a plus. American Heart Association Basic Life Support (BLS) and any additional applicable life support certification for Healthcare Providers is required upon hire with at least 6 months validity and maintenance at JHS for the duration of employment.

Unit Specific Credential

FL-ACLS
FL-PALS
FL-BLS

Working Conditions

Physical Requirements - Job function requires extended standing or walking. Must be able to carry objects weighing 21 to 50 pounds. Able to lift or move objects weighing 51 to 100 pounds with the use of appropriate devices. Jobs in this group require frequent visual acuity to perform activities related to extended use of computers. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC).

Environmental Conditions - Jobs in this group are required to function in a fast paced environment with occasional high pressure or emergent and stressful situations. Frequent interaction with a diverse population including team members, providers, patients, insurance companies and other members of the public. Function is subject to inside environmental conditions, with occasional outdoor exposures. Exposure to various environments such as: communicable diseases, toxic substances, medicinal preparations and other conditions common to a hospital and medical office environment. May also be exposed to needle sticks, airborne infections, medical gases, X-Ray, chemical exposures and other potential hazards. Must wear Personal Protective Equipment (PPE) when exposed to infectious/clinical hospital environment. Reasonable accommodations can be made to enable people with disabilities to perform the described essential functions. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC).