Admission Liaison, Tanjanique Davis-Moody, L.A. Care

What are your main responsibilities in your role as admission liaison?

We primarily manage hospital admissions for L.A. Care members who have received treatment in the emergency room or at an urgent care center or doctor’s office. For example, if a member goes to the ER and the treating M.D. feels the member needs to be admitted post-stabilization, the emergency department staff calls us.

We then review the clinical information and use our guidelines to determine whether the member meets the criteria for observation (which doesn’t require authorization from L.A. Care) or for inpatient admission (in which case we provide the authorization number).

If the member is being treated at an out-of-network hospital, we’ll do our best to bring that member to an in-network facility. If they’re out of state or otherwise cannot be brought to a network facility, we approve their out-of-network care and remain in touch with the treating facility for the duration of their stay.

Our team also manages transfer requests. For instance, a small hospital may not be able to provide the specialty services a member needs.

Are the demographics of your member base very varied?

We largely serve a vulnerable, low-income population, so our demographics reflect that. It’s a diverse range of individuals. Some members may have disabilities; others may be employed but with incomes that fall within the eligibility range for our program.

Do you interface with members directly?

I generally only speak with the treating facilities and the nurse practitioners and physicians who are treating our members. Once in a while, a member will call the number on the back of their card, typically because they’re uncertain who to call. Then, I may have a conversation with the member directly.

Tell us about a time you were able to make a difference in a patient’s care.

We had a member who was bariatric (weighing more than 400 pounds) at a community hospital. The member needed diagnostic imaging, but their current hospital did not have imaging equipment that could accommodate a bariatric patient.

When I received the request for transfer, the member had been in the emergency room for two days without having any success in finding a facility with suitable imaging equipment.  I was able to assist in finding a facility that agreed to accept the member as an outpatient. The member was able to transfer and finally get the treatment they needed.

What are the characteristics of nurses who are successful in this type of work?

You must be comfortable working independently. Know when and how to assert yourself, since we can’t give people what they want 100 percent of the time. Maintain your professionalism. Being organized is also important because you’re dealing with multiple members, multiple facilities, increased levels of care, admissions, discharges, transfers, approvals, and denials.

What do you foresee for yourself and the future of your nursing career?

I will earn my BSN next year. I’d like to step into the role of teaching nurses within our department. I love working for L.A. Care. Every member deserves to be afforded the same opportunity to receive high-quality healthcare, no matter how much money they earn or their background.

KEITH CARLSON, RN, BSN, NC-BC, has worked as a nurse since 1996 and offers expert professional coaching at www.nursekeith.com.

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