HRP Clinical Review RN

Overview

The HRP Clinical Review Registered Nurse (RN) is responsible for clinically reviewing, managing and coordinatingreferrals to the Community Transitions Care Team and Medical Respite Program, ensuring completeness andaccuracy for program admission and patient matching to the most appropriate environment. This role ensurestimely access for admission to the housing program or appropriate setting and/or services. The RN utilizes clinicalknowledge, experience, and assessment of clinical documentation for program admission. The RN serves as a keyclinical liaison among providers, patients, and internal and external stakeholders to support safe transitions tothese programs.

Responsibilities

Essential Functions:

Conduct clinical review of incoming referrals to ensure completeness and accuracy of documentation for programadmission to the Community Transitions Care Team, Medical Respite Program or other programs.Review eligibility requirements, including verification of required health coverage, to support program admission.Reviews referrals against established clinical and program criteria and determines appropriateness withinestablished parameters, making recommendations of the most appropriate level/program of care. Escalatesclinically complex, high-risk, or unclear referrals to the appropriate provider for further review and determination.Manage referral workflows to support timely decision making, prioritization, and throughput.Provide clear status updates to internal teams, providers, and external partners.Utilize nursing knowledge and clinical judgment to assess referral urgency and complexity to prioritize accordinglyfor timely placement.Conduct a thorough review of medical records to identify the most appropriate location of care transitions.Collaborate with inpatient care teams, case management, and providers to clarify referral needs and/or clinicaldocumentation.Conduct an in-person meeting with the patient to discuss individual needs, educate the patient on programofferings and admission requirements, and provide detailed information to assess for appropriateness and interest.Serve as a clinical liaison between providers, hospital case management teams, post-acute care facilities and otherexternal partners.Monitor and track referral progress and proactively follow up to ensure seamless continuity of patient care andavoid unnecessary delays.Serves as a clinical resource for complex referral and placement cases and provides recommendations toleadership regarding referral criteria, workflow, clinical appropriateness, access barriers and program capacity.Identifies trends in referral patterns, clinical complexity, placement barriers and outcomes and recommendsprocess improvements to improve access, continuity and appropriate utilizationFacilitates communication and coordination with program teams regarding clinical acceptance, patient intake, andplacement into appropriate programs, including Medical Respite, shelter, transitional housing, and permanenthousing.Attends staff meetings, huddles, and education offerings (in person and virtual) to maintain role competency anddepartment alignment.Supports organizational and departmental initiatives to promote and maintain a collaborative and positiveworkplace culture.Maintain accurate, timely, and appropriate documentation of referral reviews, determinations, and carecoordination activities in the electronic health record system.Adhere to HIPAA compliance, organizational policies and regulatory standards.Awareness of department performance indicators, metrics, and quality measures.Performs other duties as assigned.

Knowledge, Skills and Abilities:

Knowledge and proficiency in the practice of nursing and documentation requirements Knowledge of acute and post-acute care settings. Knowledge of medical necessity and utilization review concepts and documentation standards Ability to work with medical and nursing staff to establish and maintain clinical and operationalstandards of practice Ability to work in a highly collaborative manner with patients and other internal or external serviceproviders Knowledge of electronic health record systems and clinical documentation workflows Ability to deliver high‑quality customer service through telephone, electronic, and in‑personcommunication Strong problem‑solving skills to identify and address barriers to better serve patients and staff Proficiency in applying Microsoft Office software tools in a system environment Strong attention to detail and accuracy Strong assessment, critical thinking and effective decision-making skills Knowledge of complex medical conditions and comorbidities Ability to apply independent nursing judgment in reviewing referrals, assessing medical necessity,and determining appropriateness Ability to thrive in a complex and dynamic work environment with multidisciplinary, cross-functionalteams and matrixed team structures Knowledge of social determinants of health issues and demonstrate cultural humility and sensitivitywhen working with underserved patient populations Skill in triaging and ensuring appropriate level of care for patients. Ability to maintain professionalism, confidentiality, and ethical standards in all interactions.

Qualifications

QUALIFICATIONS

Education:

Associates Degree (higher degree accepted) Graduation from an accredited school of nursing with an Associate Degree in Nursing (ADN) -Required

Work Experience:

2 years - Minimum of 2 years of clinical nursing experience (preferably acute care, ambulatory or case management) is required

1 year Experience with referral review and coordination -Preferred1 year Experience determining medical necessity -Preferred 1 year Experience Epic EHR -Preferred

Licenses and Certifications:

Registered Nurse (RN) - State Licensure and/or Compact State License Current unrestricted RN license to practice nursing in the State of Texas -Upon Hire Required

BLS - Basic Life Support Basic Life Support (BLS) - Obtained through approved American Heart Association Training Network - Upon Hire Required

Driver's License Valid Driver's License Upon Hire -Required