Patient Hub Lead

Job Summary: 

The Patient Hub Lead is to be first point of contact for Patient Hub Coordinators and Case Managers for questions regarding internal and external requested transfers coming into Pipeline Health’s Patient Hub Transfer Center and facilitates a timely response based on the adherence of transfer processes and escalations.  The Patient Hub Lead works with the Patient Hub Manager providing education and training to both existing and new staff members.  The Patient Hub lead attends and facilitates meetings as requested.  The Patient Hub Lead works closely with the remote Utilization Review (UR) Nurses to assure the patient meets inpatient status prior to accepting the transfer. Actively and consistently contributes to department operations and communications, behaves in a manner consistent with the mission, vision, and values of Pipeline Health, upholding standards of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank you) patient communication. Lead obtains demographic info, pre-registers the account and verifies insurance eligibility. Lead obtains appropriate authorization as needed and directed by leadership.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

 

Essential Functions: 

• Provide education and training to Coordinators and Case Managers. 
• Act as a resource to Coordinators and Case Managers.
• Review Transferred, Pending, Canceled and Declined accounts each shift ensuring accuracy and reporting outcome to Patient Hub Manager.
• Attend meetings and take lead at meetings as requested.
• Monitor InterQual Queues ensuring 100% availability for review.
• Closely monitor and process HLOC requests.
• Assist with monthly schedules.
• Obtain warm handoff with off going shift following up immediately with any open task/transfer duties.
• Assure transfer phone line is answered immediately when a call comes in.
• Check message line after every transfer call completed to pick up voice mails timely and facilitate the request for transfers.
• Check message line immediately after breaks to pick up voice mails timely and facilitate the request for transfers.
• Screen all transfer requests for Inpatient medical necessity and level of care needed through the remote UR Nurses to place the patient in one of Pipeline Health’s hospitals appropriately.
• Adhere to the detailed algorithm to comply with the 30-minute timeframe of notifying the facility of acceptance, with the hospital and bed assignment.
• Adhere to payor/hospital partners specific rules and requirements related to authorizations and transfers.
• Follow escalation process if any barrier to the transfer process is identified.
• Assure documentation is accurate, timely and thorough for all transfers utilizing the appropriate log(s).
• Assist with the Treatment Authorization Review (TAR) process as instructed.
• Uses clear, concise, professional communication with coworkers, patients, all customers internal and external.
• Uses AIDET in interactions with patients and family members.
• Acts with a sense of urgency when performing tasks.
• Basic unit/department maintenance such as keeping files, drawers, cabinets free from unnecessary clutter.
• Reports on any equipment and or environmental issues for repair.
• Abides by HIPAA (Health Insurance Portability and Accountability Act) regulations.
• Speaks up to stop the line and escalates potential safety events if necessary.
• Completes and attends monthly training assigned.
• Verify insurance eligibility.
• Obtain patient demographic and pre-register.
• Document and Scan any appropriate documentation in account notes.
• Other duties as assigned.

Behavioral Standards: 

• Treats everyone as their customer; utilizes scripting and other tools to ensure consistency in customer service; Expresses recognition and shows appreciation to others; fully utilizes AIDET principles; responds quickly to handle requests, complaints and questions; displays a positive attitude.
• Demonstrates the highest level of professionalism, passion and care when interacting with patients, families, physicians, and hospital staff members.
• Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential, embracing ingenuity to service our customers. 

Communication/Knowledge: 

• Wears nametag properly; follows dress code policy; answers phone correctly and promptly; is prepared for meetings; meets deadlines; does not participate in gossip