Deb Jones is an Optima Research Nurse who frequently deals with patients seeking care for complicated medical problems, often from an out of network provider. Recently, she received an out of area request for a patient in need of a specialty surgery. Of course, this request was received late on a Friday afternoon for surgery that was scheduled out of network on the following Monday. Knowing the medical information provided was insufficient to support approval of the procedure, she put the wheels in motion to take care of the patient. Reaching out to the neurologist, vascular surgeon, primary care physician, cardiothoracic surgeon and cardiologist who had been treating the patient was a time consuming and sometimes frustrating endeavor. Finally, by Friday at 5 pm, she received sufficient records to identify why the patient required specialty care that wasn't available in the Optima Network.
Because she made sure a medical director was on standby ahead of time to assist her with the case, she secured an approval from the medical director and was able to notify the treating physician and facility. She didn't let the long hours or the fact that she faced barriers every step of the way interfere with doing the right thing for the patient. The patient was extremely grateful that someone was able to take the time to ensure he received the proper medical care at a critical time in his illness.
Deb consistently supports her co-workers in good times and hard times. She has a way about her that empowers her team in such a caring manner, the same way she cares about the patients she helps.
Congratulations to DAISY Honoree Deb Jones from Medical Care Services!