Navajo Preference Employment Act In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference. Overview POSITION SUMMARY The Utilization Review (UR) Nurse ensures that patients receive appropriate care by verifying medical necessity, confirming the correct patient status, and monitoring the ongoing need for services while working to reduce unnecessary length of stay and prevent delays; they support accurate clinical documentation for proper reimbursement, coordinate with providers and the care team on discharge planning and transitions, manage resource use to control costs, communicate with payers to prevent denials, and ensure compliance with CMS and Joint Commission requirements while contributing to reporting and quality improvement efforts. They also serve as a key liaison between clinical care, finance, and regulatory requirements, helping align patient care with both quality standards and reimbursement rules. Ultimately, their role has a direct impact on patient outcomes, hospital efficiency, and the organization’s financial performance. Qualifications NECESSARY QUALIFICATIONS Education: Bachelor’s Degree in Nursing License/Certification: A valid, current, full and unrestricted Professional Nursing License to practice as a Registered Nurse (RN) in any state of the United States of America, The Commonwealth of Puerto Rico, or a territory of the United States Must have and maintain current Basic Life Support (BLS) certification by the American Heart Association (AHA) throughout employment Experience: Three (3) years of clinical nursing experience performing direct patient care with at least 2 years in an Inpatient setting on a medical-surgical unit, PACU, or higher acuity Inpatient unit (ICU, Step-Down, Telemetry, etc.) or home health (direct care) {clinical experience qualification may be determined by hiring manager/director.} Demonstrate knowledge of case management, purchased referred care and utilization review Demonstrate knowledge of electronic health record systems. Other Skills and Abilities: A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas: Positive working relationships with others Possession of high ethical standards and no history of complaints Reliable and dependable; reports to work as scheduled without excessive absences Effective verbal & written communication skills Team management focus promoting a positive and pro-active approach to problem resolution Experience in hospital-based utilization review Proficient or experienced with clinical criteria sets for Miliman Care Guidelines(MCG) Completion of and receiving above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewers and TCRHCC that the applicant can perform the essential functions of the job Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading or incomplete information, as determined by TCRHCC. MENTAL AND PHYSICAL EFFORT The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Physical: This position requires an individual of high energy who can maintain a long and flexible schedule to meet the management requirements. The physical requirements include; sitting at a desk for long periods of time, long periods of sitting in meetings; frequent sitting for intense work on a personal computer, frequent walking to interact with staff within the facility, frequent bending, kneeling, crouching, twisting, maintaining balance and reaching. Must be able to hear, speak and comprehend over the telephone and in person with others. Must have ability to lift, push and pull up to 50lbs frequently. Sensory requirements for position include prolonged ability for far, near, and color vision, depth perception, seeing fine details, hearing normal speech, telephone use and ability to frequently hear overhead pages. Must have ability of both hand manipulation in simple and firm grasping, fine manipulation, and use of keyboard. Mental: Uses independent judgment and analytical skills to make decisions that impact operations, finances, and customer service within the organization. The incumbent must have the ability to perform in structured and unstructured environments and possess a keen attention to detail and propose practices/mechanisms to enhance customer satisfaction. Must have ability to continually concentrate, handle a high degree of flexibility, handle multiple priorities in stressful situation, demonstrate high degree of patience, adapt to shift work, work in areas that are close in crowded, frequently cope with high levels of stress, make decisions under high pressure, work alone, and occasionally cope with anger/fear/hostility of others in a calm way and manage altercations. Environmental: May frequently be exposed to chemical agents, extremes in temperature of humidity, occasional exposure to infectious diseases, dust, fumes, gases, hazardous or moving equipment, and loud noises. Responsibilities ESSENTIAL FUNCTIONS Adheres to most current ACMA Case Management Standards of Practice and Scope of Services Adheres to ANA Nursing Scope and Standards of Practice Adheres to most current ANA The Code of Ethics for Nurses Coordination of service specific assessments, service planning and enrollment. Works with all facets of the Case Management continuum, i.e., social support, alternate resources, community referrals, discharge planning, Nursing Home/Skilled Nursing Placement and resource utilization. Comprehensive and client centered service planning and coordination Works proactively with the established RN Case Managers/ Social Workers of TCRHCC as a team member for care coordination of the patient populations served by TCRHCC. Consistent and on-going case consultation with all direct service providers. Developing and maintaining internal and external resource relationships. Promote patient advocacy Promote quality of care Promote cost effective medical outcomes Promote appropriate admission status Provide continuity of care between utilization management and care coordinators Commits to professional development towards becoming an expert in utilization management including but not limited to: Knowing Medicare rules and regulations related to utilization Knowing payor policies related to utilization management Knowing TCRHCC 638 policies related to utilization management. Keeping abreast of current changes affecting utilization management as applicable. Collaborates with attending physician if ambiguous documentation pertaining to patient status placement requires clarification. Utilizes electronic utilization management database for documentation of interventions and communications (MCG Guidelines, Careport and Allscripts) Reviews precertification requests for medical necessity for all payors as applicable, referring to the second level physician reviewer those that require additional expertise Collaborates with payor utilization management liaisons and medical directors as applicable. Uses clinical and analytical skills to review and interpret diagnostic test results to determine appropriateness of patient's level of care. Assists with the development of department reports, policy/procedures manuals, and program objectives Conduct system and procedural efficiency evaluation to determine progress, performance, and conformity with program requirements. Will provide a consistent and on-going collaboration through communication with service providers. Facilitates appropriate clinical documentation to ensure that the level of services and acuity of care are accurately reflected in the medical record. Improves the overall quality and completeness of clinical documentation by performing admission/continued stay clinical reviews using clinical enhancement guidelines for selected patient populations. Reviews clinical issues as needed with the coding staff to assign a working DRG to reflect any changes in patient status and procedures/treatments and confers with the physician to finalize diagnoses. Conducts timely follow-up reviews of clinical documentation to ensure that issues discussed and clarified with the physician have been recorded in the patient’s chart. Participates in review and analysis of monthly data relating to clinical quality documentation and insurance medical necessity criteria. Ensure proper PPE is worn at all times while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield. Completes all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC website for most current updated) Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee and external customer satisfaction. Performs other duties as assigned.
Navajo Preference Employment Act In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference. Overview POSITION SUMMARY Incumbent serves as an Outpatient/Inpatient Nurse Case Manager for TCRHCC and at Sacred Peaks Healthcare Center (SPHC) as the supportive contact for specified groups of identified high risk patients; will specifically focus on specialty clinics that need specific Case Management attention. The case manager meets essential health and social needs for patients while ensuring quality, cost effective healthcare. The case manager facilitates care transitions from admission through discharge ensuring continuity of care, alignment of services, and post hospital referrals to continuing care agencies. Also serves as a resource for nursing, physicians and ancillary departments on transitional and regulatory issues. The case manager will experience working with culturally diverse patient populations having multiple barriers to self-sufficiency such as: illiteracy, welfare dependency, domestic violence, substance abuse, and mental health issues. The Nurse Case Manager will be responsible for assessment, service planning, resource acquisition, monitoring progress and initiating the responding to emerging client needs. Collaborates with an interdisciplinary team to assess care plans, monitor progress, and make recommendations to ensure safe and efficient hospitalizations. Responsible for evaluating patients in the ED for medical necessity and care coordination needs. Assesses potential admissions and works with advanced practice clinicians/physicians to determine appropriate admission status. Proposes and implements outpatient plans for safe discharge from the ED with physician approval. Coordinates care for patients with abuse, chronic pain, and frequent utilization issues. Interacts with patients or customers of all ages, from newborn to geriatric. As part of this role, they will also interact with individuals who have mental health issues to help them access and navigate the resources they need to improve their well-being. with individuals who have mental health issues to help them access and navigate the resources they need to improve their well-being. Qualifications NECESSARY QUALIFICATIONS Education: Associate’s or Bachelor’s Degree in Nursing Certifications/License: A valid, current, full and unrestricted Professional Nursing License to practice nursing in any state of the United States of America, The Commonwealth of Puerto Rico, or a territory of the United States Must have and maintain current Basic Life Support (BLS) certification by the American Heart Association throughout employment Experience: Three (3) years of clinical nursing experience with (1) year in an Outpatient/Inpatient setting Demonstrated knowledge of the case management, contract health, and utilization review processes Other Skills and Abilities: A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas: Positive working relationships with others Possession of high ethical standards and no history of complaints Reliable and dependable; reports to work as scheduled without excessive absences Effective verbal & written communication skills Team management focus promoting a positive and pro-active approach to problem resolution Completion of and above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading, or incomplete information, as determined by TCRHCC. MENTAL AND PHYSICAL EFFORT The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Physical: Work requires walking, periods of standing, and sitting. Work also requires extensive periods of time working at a personal computer. Must be able to lift up to 25 lbs (i.e. medical charts); must be able to distinguish numbers, letters, and colors. Mental: Contacts often require tact and sensitivity as those related to stressful situations such as death, dying and catastrophic illnesses. Must be able to prioritize, use good judgment, and coordinate a variety of issues while being frequently interrupted. Responsibilities ESSENTIAL FUNCTIONS Provides comprehensive and client centered service planning and coordination for a specified group of high-risk patients. Manages care of prioritized TCRHCC/SPHC outpatient/inpatient based upon consultation from providers within the TCRHCC/SPHC healthcare delivery system; provides a consistent and on-going consultation with service providers. Works collaboratively with providers and other disciplines to develop and maintain high risk patient database to ensure the continuity of care is established and maintained for the TCRHCC/SPHC outpatient/inpatient population. Works proactively and collaboratively with Utilization Review (UR), Public Health Nursing (PHN), Patient Benefit Coordinators (PBC), and Purchased Referred Care (PRC) at TCRHCC/SPHC. Facilitate communication and coordination between members of the health care team, involving the client in the decision-making process in order to minimize fragmentation in the services (CMSA, 2010). Independently develops and maintains resource databases to ensure timely and accurate information for patient referrals and minimize fragmentation in patient care services. Develops with the patient/family and multidisciplinary team (including service area and/or other non-TCRHCC/SPHC providers as appropriate) a care and service delivery plan based upon the needs identified and available provider and financial resources of the patient and provides consistent and on-going case consultation with all direct service providers. Provides service monitors and follow-up to ensure continuity of care, and updates of the client service plan and provides follow up if needed. Striving to promote client self-advocacy and self-determination (CMSA, 2010). Prepares patient and family for termination (discharge) from case management when services are no longer required. Arranges for any ongoing support/direct care services that the patient will need post-discharge in coordination with discharge planners and other entities such as PHN, Community Health Representatives or Tribal Social Services. Develops reports, performance improvement projects, establishes policy and procedures and program objectives. Will provide Case Management coverage for the Adult Care Unit, Pediatric Unit, Intensive Care Unit, Obstetrics Unit, Emergency Room and Outpatient Departments. Will be familiar with Advance Directives and be a resource person for patients and families; facilitate informed choice, consent, and decision-making. Promote use of evidence-based care, as available, in conjunction with the MCG Care Guidelines. Pursue professional excellence and maintain competence in practice. Serves as the outpatient/inpatient coordinator, such as: The primary contact for outpatient/inpatient in obtaining beds for admissions both within and outside of TCRHCC/SPHC. Collaborate with provider and nursing personnel to ensure admissions are conducted seamlessly and without delay of patient care. Collaborates with provider, nursing personnel and patient benefits coordinators that all admission documentation is complete and all referrals for third party resources are complete prior to the departure of patients. Required to take call on scheduled weekends as deemed necessary. Ensure proper PPE is worn at all times while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield. Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC website for most current updates) Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee, and external customer satisfaction. Performs Other Duties as Assigned.
Navajo Preference Employment Act In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference. Overview POSITION SUMMARY This position serves as a Physician Assistant (PA) or Nurse Practitioner (NP), which involves performance of medical care services for patients of all ages in the Emergency Department. Interviews, assesses, and evaluates patients to determine their physical condition and type of medical services needed, and orders initial diagnostic studies appropriate for the patient’s medical condition. Qualifications NECESSARY QUALIFICATIONS Education: Bachelor’s Degree in Nursing or Physician Assistant studies Experience: At least 2 years’ experience working in emergency department or urgent care setting. Comfort with the treatment and management urgent and emergency conditions from suturing to fracture reduction to sick patient with abdominal pain; sees 4 patients per hour continuously for 12-hour shift in Fast Track setting; and has a good command of ACEP Standards and clinical policies. Licensure/Certification: Must possess a valid, current, full and unrestricted license to practice as a nurse practitioner in any state within the United States, District of Columbia, or the Commonwealth of Puerto Rico Must possess a certificate from the NCCPA (National Commission for Certified Physician Assistants) or the American Association of Nurse Practitioners. Credentialing: Must be credentialed and privileged to serve on the Medical Staff Other Skills and Abilities: A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas: Positive working relationships with others; has the ability to work effectively in a culturally diverse environment Possession of high ethical standards and no history of complaints Reliable and dependable; reports to work as scheduled without excessive absences Must possess excellent communication and interpersonal skills to optimize the care of patients Excellent clinical skills and judgment Is seen as a staff member who is trustworthy and willing to share information Is a mentor to colleagues and other organizational staff Responds effectively to sensitive inquiries or complaints Completion of and above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading or incomplete information, as determined by TCRHCC MENTAL AND PHYSICAL EFFORT The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Physical: Must have ability of prolonged walking and maintaining balance, ability to frequently stand, bend, kneel, crouch, maintain balance, reach, and occasionally sit, drive, and climb. Frequent ability to lift, push, and pull up to 34lbs is required, must also be able to occasionally lift, push, and pull over 100lbs as needed. Sensory requirements for position include prolonged ability of far, near, color vision, depth perception, seeing fine details, hearing normal speech, hearing overhead pages, and telephone use. Must have both hand manipulation of continuous simple and firm grasping, fine manipulation and frequent use of keyboards. Mental: Must be able to perform evenings, nights, and weekends on a regular basis and handle the stresses of rural medicine with critically ill patients; must have high degree of judgment and leadership in coordinating emergency services. Must have ability to cope with high level of stress, make decisions under high pressure, concentrate, handle a high degree of flexibility handle multiple priorities in stressful situation, work alone, demonstrate high degree of patience, adapt to shift work, work in areas that are close and crowded, and frequently cope with anger/fear/hostility of others in a calm way, as well as occasionally managing altercations. Must accept a flexible schedule to meet unit needs. Environmental: May be exposed to infectious diseases for a prolonged amount of time, frequent exposure to loud noises, and occasional exposure to chemical agents, and hazardous or moving equipment. Responsibilities ESSENTIAL FUNCTIONS Provides comprehensive diagnostic, preventative, and therapeutic health care services to patients. Documents visits in the medical records of patients including updating problem lists. Secures a health and developmental history from the patient or parent, records findings and contributes in making critical evaluations. Performs or requests special screening and developmental tests and laboratory tests and reviews and interprets obvious results. Provides emergency services or crisis intervention in the absence of the physician. Review and evaluates the nursing and medical aspects of care, plans periodically, recognizing when there is a need for reassessment by the physician or other health professionals. Gives direct physical and psychological care in emergencies and in the presence of illness or disability in order to maintain life, provide comfort, reduce distress and enhance coping ability. Identifies and manages a full range of complex to general illnesses. Comfortable handling of basic trauma, suturing, fracture reduction, chest pain & abdominal pain work up. Performs a basic physical assessment using techniques of observation, inspection, auscultation, percussion, palpation and diagnostic instruments. Discriminates between normal and abnormal findings to recognize early stages of serious physical, emotional, and mental problems. Consults and collaborates with other health care professionals to establish health care plans and to review patient progress and response to therapy, including the use of written referrals to Community Health Nurses, specialty clinics, schools, etc. Adheres to medical regimens to stabilize chronically ill persons and adjusts regimens within established protocols. Makes decisions concerning medical care needs of patients consulting with physicians as appropriate. Works collaboratively with the physician in management of selected complex medical problems. Makes referrals for home visits when indicted to implement a care plan based on family needs. Provides health care and preventive services to healthy individuals including immunizations, guidance in nutrition, common illnesses, accidents, child growth and development, substance abuse, exercise, and depression screening. Teaches patients and family member(s) ways to maintain or improve their health status. Carries out treatments and procedures, administers medications; observes and documents changes in patient’s condition, reactions to medications and treatments. Responsible for prescribing medications including computation of doses. Participates in planning, instituting, evaluating, and revision program plan, assist in determining conditions, resources, and policies essential to delivery of health care services. Participates in a teaching capacity in the development of other health care workers. Participates in performance improvement initiatives which may involve chart reviews, studies relevant to health care and nursing needs of patients. Keeps abreast of the latest medical knowledge via CME as required by respective licensing agency. Handwriting must be legible and must be willing to use an Electronic Health Record. Ensure proper PPE is always worn while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield. Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC website for most current updates) Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee, and external customer satisfaction. Responsible for electronic health records data entry pertinent to patient service role. Performs other duties as assigned.
Navajo Preference Employment Act In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference. Overview POSITION SUMMARY This position serves as a Physician Assistant (PA) or Nurse Practitioner (NP), which involves performance of medical care services for patients of all ages in the Emergency Department. Interviews, assesses, and evaluates patients to determine their physical condition and type of medical services needed, and orders initial diagnostic studies appropriate for the patient’s medical condition. Qualifications NECESSARY QUALIFICATIONS Education: Master of Science in Nursing or Doctor of Nursing Practice OR Master’s degree in Physician Assistant studies Experience: Nurse Practitione r Must have a minimum of 2 years of Acute Care Nursing (RN) experience. Physician Assistant Completed clinical rotation in a high-acuity Emergency Department under direct supervision of board-certified Emergency Medicine Physicians and PA’s. Licensure/Certification: Must possess a valid, current, full and unrestricted license to practice as a nurse practitioner or Physician Assitant in any state within the United States, District of Columbia, or the Commonwealth of Puerto Rico Must possess a certificate from the NCCPA (National Commission for Certified Physician Assistants) or the American Association of Nurse Practitioners. Credentialing: Must be credentialed and privileged to serve on the Medical Staff Other Skills and Abilities: A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas: Positive working relationships with others; has the ability to work effectively in a culturally diverse environment Possession of high ethical standards and no history of complaints Reliable and dependable; reports to work as scheduled without excessive absences Must possess excellent communication and interpersonal skills to optimize the care of patients Excellent clinical skills and judgment Is seen as a staff member who is trustworthy and willing to share information Is a mentor to colleagues and other organizational staff Responds effectively to sensitive inquiries or complaints Completion of and above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading or incomplete information, as determined by TCRHCC MENTAL AND PHYSICAL EFFORT The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Physical: Must have ability of prolonged walking and maintaining balance, ability to frequently stand, bend, kneel, crouch, maintain balance, reach, and occasionally sit, drive, and climb. Frequent ability to lift, push, and pull up to 34lbs is required, must also be able to occasionally lift, push, and pull over 100lbs as needed. Sensory requirements for position include prolonged ability of far, near, color vision, depth perception, seeing fine details, hearing normal speech, hearing overhead pages, and telephone use. Must have both hand manipulation of continuous simple and firm grasping, fine manipulation and frequent use of keyboards. Mental: Must be able to perform evenings, nights, and weekends on a regular basis and handle the stresses of rural medicine with critically ill patients; must have high degree of judgment and leadership in coordinating emergency services. Must have ability to cope with high level of stress, make decisions under high pressure, concentrate, handle a high degree of flexibility handle multiple priorities in stressful situation, work alone, demonstrate high degree of patience, adapt to shift work, work in areas that are close and crowded, and frequently cope with anger/fear/hostility of others in a calm way, as well as occasionally managing altercations. Must accept a flexible schedule to meet unit needs. Environmental: May be exposed to infectious diseases for a prolonged amount of time, frequent exposure to loud noises, and occasional exposure to chemical agents, and hazardous or moving equipment. Responsibilities ESSENTIAL FUNCTIONS Provides comprehensive diagnostic, preventative, and therapeutic health care services to patients. Documents visits in the medical records of patients including updating problem lists. Secures a health and developmental history from the patient or parent, records findings and contributes in making critical evaluations. Performs or requests special screening and developmental tests and laboratory tests and reviews and interprets obvious results. Provides emergency services or crisis intervention in the absence of the physician. Review and evaluates the nursing and medical aspects of care, plans periodically, recognizing when there is a need for reassessment by the physician or other health professionals. Gives direct physical and psychological care in emergencies and in the presence of illness or disability in order to maintain life, provide comfort, reduce distress and enhance coping ability. Identifies and manages a full range of complex to general illnesses. Comfortable handling of basic trauma, suturing, fracture reduction, chest pain & abdominal pain work up. Performs a basic physical assessment using techniques of observation, inspection, auscultation, percussion, palpation and diagnostic instruments. Discriminates between normal and abnormal findings to recognize early stages of serious physical, emotional, and mental problems. Consults and collaborates with other health care professionals to establish health care plans and to review patient progress and response to therapy, including the use of written referrals to Community Health Nurses, specialty clinics, schools, etc. Adheres to medical regimens to stabilize chronically ill persons and adjusts regimens within established protocols. Makes decisions concerning medical care needs of patients consulting with physicians as appropriate. Works collaboratively with the physician in management of selected complex medical problems. Makes referrals for home visits when indicted to implement a care plan based on family needs. Provides health care and preventive services to healthy individuals including immunizations, guidance in nutrition, common illnesses, accidents, child growth and development, substance abuse, exercise, and depression screening. Teaches patients and family member(s) ways to maintain or improve their health status. Carries out treatments and procedures, administers medications; observes and documents changes in patient’s condition, reactions to medications and treatments. Responsible for prescribing medications including computation of doses. Participates in planning, instituting, evaluating, and revision program plan, assist in determining conditions, resources, and policies essential to delivery of health care services. Participates in a teaching capacity in the development of other health care workers. Participates in performance improvement initiatives which may involve chart reviews, studies relevant to health care and nursing needs of patients. Keeps abreast of the latest medical knowledge via CME as required by respective licensing agency. Handwriting must be legible and must be willing to use an Electronic Health Record. Ensure proper PPE is always worn while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield. Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC website for most current updates) Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee, and external customer satisfaction. Responsible for electronic health records data entry pertinent to patient service role. Performs other duties as assigned.
Navajo Preference Employment Act In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference. Overview POSITION SUMMARY The purpose and overall goal of Pre-Anesthesia Screening (PAS) is to gather the clinical information necessary for the safe and effective administration of anesthesia through a process that is convenient for patients and physicians and results in efficient surgical throughput. The Nurse Practitioner of the Pre-Op clinic has overall supervision of the pre-operative clinic provided in the Surgery area, in addition to the flow of the pre-surgical testing and pre anesthesia clearance for patients to gain admittance to the operating room. The Nurse practitioner of the Pre-op clinic will provide input and assist with major decision making processes in regards to cardiac, pulmonary, and overall general health clearance for optimizing the health of patients who will undergo future surgery. They will play a major role in collaboration with the CRNA team and Internal Medicine department to decide if a patient is physically fit to undergo surgery and to decide if the patient’s laboratory markers deem them to be safe candidates for the administration of general anesthesia. Through the development of algorithms and checklists by the CRNA and surgical/Internal medicine team the NP of the Pre-OP clinic will follow these flowsheets to ensure safety of the surgical patient. This pre-op clearance process will allow EKG’s, labs, concerning physical disabilities, medication issues, and allergies to be pre-assessed prior to the day of surgery optimizing patient outcomes and preventing medical errors. The NP of Pre-op clinic will work along with the Chief CRNA to improve overall flow, function, safety and efficiency of the pre-operative and pre-anesthesia processes. Qualifications NECESSARY QUALIFICATIONS Education: Master of Science in Nursing (MSN) – Family Nurse Practitioner (FNP ) Experience: Must have completed a nurse practitioner degree Experience in a pre-op clinic setting preferred Must have active CPR/BLS certification 1-3 years of experience as an RN Mental: Licensure/Certification: Must possess a valid, current, full and unrestricted license to practice as a Nurse Practitioner in any state within the United States, District of Columbia, or the Commonwealth of Puerto Rico Must be credentialed to serve on the Medical Staff (provide all related information as requested and needed for credentialing process) Other Skills and Abilities: A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas: Positive working relationships with others Possession of high ethical standards and no history of complaints Reliable and dependable; reports to work as scheduled without excessive absences Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading, or incomplete information, as determined by TCRHCC. MENTAL AND PHYSICAL EFFORT The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Physical: The Incumbent must be able to frequently sit, stand, walk, bend, kneel, crouch, twist, maintain balance, and reach. Must be ability to lift, push, pull up to 10 pounds frequently and occasionally help with lifting, pushing, pulling greater than 10 pounds. Must have the ability to frequently utilize sensory requirements of far vision, near vision, depth perception, seeing fine details, and hearing normal speech frequently. Incumbent must also be able to hear overhead pages over a loudspeaker at times. The Incumbent must have the hand manipulation ability to do simple grasping and use of keyboards. The position will require the Incumbent to be exposed frequently to infectious disease, chemical agents, dust, fumes, gases, and hazardous or moving equipment frequently. Occasionally may be exposed to extremes in temperatures or humidity, unprotected heights, and loud noises. Mental: The Incumbent must be autonomous with working alone for prolonged periods of time. Must be able to frequently cope with high level of stress; cope with anger/fear/hostility of others in a calm way; concentrate; handle a high degree of flexibility; handle multiple priorities in stressful situation; demonstrate a high degree of patience; and work in areas that are close and crowded. The Incumbent may frequently need the ability to make decisions under high pressure; manage altercations; and, adapt to shift work. Responsibilities ESSENTIAL FUNCTIONS Serves as Nurse practitioner of the pre-op clinic, incumbent assigns, directs all nurses and staff in the pre-op clinic. Serves under the Chief of CRNA and is directed by the Chief CRNA and all responsibilities. Oversees the day-to-day tasks and activities of pre-op clinic. This includes evaluating ALL patients sent from surgical clinics in a timely fashion to be evaluated and cleared for surgery. This will include a medical history to include allergies and medications, family history of anesthesia complications, physical exam and assessment through algorithms for readiness for surgery. When health or medical concerns arise, the NP will have a dual collaboration with the CRNA present a plan for surgical clearance. Consults to CRNA and IM should be made for all high risk patients. Cardiac clearance and pulmonary clearance may be needed and future testing will ultimately be determined by the CRNA or IM physician. The NP will be responsible for collecting labs and performing the EKG in the pre- op clinic. Supervises the activities of the staff in the pre-op clinic. Ensuring the patients are receiving the appropriate educational information from the pre-op nurse as well as appropriate pre-operative preps to include but not limited to bowel preps, antibiotics, and pre-op at home surgical preps. Provides input and attends meetings for all departments directly affected by pre-operative services. Plans, organizes, coordinates, and directs the operational services of pre-op clinic along with the Chief CRNA, both advise the Chief of Surgical Services, Medical Officer and the Chief Executive Officer of TCRHCC on perioperative matters concerning the pre-anesthesia testing clinic. Participates with members of other departments, in planning joint administrative and technical programs; and making recommendations for maximum coordination of pre-operative services with other patient services. Along with the Chief of Anesthesia, incumbent is also responsible for assuring that TCRHCC meets the requirements of the Joint Commission on Accreditation of Hospitals (JCAHO) with regard to quality of care within the pre-operative anesthesia clinic and assures that hospital policies and procedures are followed. Committee responsibilities include OR committee attendance. Incorporates cultural and developmental needs into plan of care. Provides documentation of patient care in the patient record according to established standards of care. Participates in performance improvement activities which include collecting, analyzing data to identify quantifiable measures to maintain quality and the promotion of desired outcomes. Perform preoperative diagnostic procedures accurately and according to standards, policies, and procedures. Demonstrates competency in performing phlebotomy, obtaining various types of laboratory specimens, electrocardiograms, or other diagnostic tests. Effectively explains perioperative instructions, perioperative treatments, patient care principles, and nursing goals to patient and family/significant others. Ensure proper PPE is always worn while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield. Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC website for most current updates) Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee, and external customer satisfaction. Completes all patient care documentation in the electronic health record entries accurately and in real-time. Participates in departmental workflow and or testing teams as related to electronic health record or other project initiatives Perform other duties as assigned or directed.
