ECM Hub Nurse

Job Brief

Emergency Care Management (ECM) Hub LPN

The position is staffed by a Licensed Practical Nurse who utilizes the nursing process and clinical skills to prioritize/triage provider calls regarding repatriation/intrapatriation of members, adhering to organizational policies, procedures, and guidelines. The LPN will support the ECM Hub MD in repatriating members from noncore Emergency Rooms or inpatient/observation status within the Kaiser Permanente Georgia Region and assist with transfers/admissions of members.

The LPN may also assist with coordinating transfers back into the service area of Kaiser members with acute illnesses or injuries sustained while traveling outside of the Georgia Region as indicated by the medical condition of the member.

The position will be responsible for:

• Locating members at non-core facilities, including identification of ER or IP room number; verifying attending MD name and phone number.
• Verifying member eligibility.
• Obtaining and communicating pertinent clinical information to the ECM Hub MD.
• Assisting MD in obtaining hospital bed, vital signs, arranging ambulance transport, and other coordination as needed.
• Leading and guiding Support Staff when needed.
• Initiating follow-up appointments or other coordination of care as directed by the ECM Hub MD.
• Facilitating urgent and non-emergency same‑day ambulance transports for all KP members as appropriate.

• Receive incoming calls via the ECM hub queue line from KP and outside providers, gather initial pertinent information including clinical information, verify benefits & eligibility, and prioritize call.
• Open Health Connect ECM Hub Encounter for each call received with accurate documentation including name of responsible practitioner, best contact phone number, patient location, payer status, and any pertinent clinical information. Screen Health Connect In‑basket Referral Request folder for members in noncore facilities. Locate members by facility, obtain location/room number, identify attending MD and contact information, verify member eligibility & benefits.
  
  Contact ECM Hub MD with member information.
• Daily follow‑up calls to obtain ongoing clinical information for members remaining inpatient at noncore hospitals. Link ECM Hub MD to responsible practitioner by phone.
• Route encounters to the appropriate Quality Resource Management department pool for admission authorization/concurrent review or for potential denial.
• Review same‑day requests for non‑emergent ambulance transport utilizing knowledge of approved origin/destination and medical necessity criteria. Follow documented processes for approval and denial.
• Provide verbal communication to members/designated family members or representative, in accordance with policy and procedure with respect to potential transfers.
• Achieve and maintain an understanding of relevant state and federal regulations, criteria, and documentation requirements and laws that affect managed care, home health and case/utilization management.
• Facilitate transfer of members to inpatient and ED beds which includes obtaining a hospital bed, ensuring an accepting MD is obtained, arranging ambulance transport when required, ensuring appropriate clinical information (imaging results on disc, etc.) accompanies member.
• Perform other duties as assigned which include but are not limited to:
  • Monitoring Cortext, Transportation and Emory Transfer Center Teams chats.
  • Arrange follow‑up appointments as needed.
  • Screen in‑basket messages in Health Connect; follow‑up as needed.

• Unrestricted current LPN licensure in the state of Georgia required.
• Valid Georgia driver’s license.
• Two (2) years of experience in a clinical setting.
• Working knowledge of all federal, state, local and regulatory requirements.
• Functional knowledge of computers.
• Functional knowledge of computer applications.
• Three (3) years of clinical nursing preferably in an acute care setting.
• One (1) year of experience with managed health care delivery including Medicare.

• Generous paid time off.
• Many additional benefits that support your work/life balance.

TSPMG is an equal opportunity employer. All applicants will be considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran or disability status. We maintain a drug‑free workplace and perform pre‑employment substance abuse testing and background checks.