RN-ED Case Manager

Sign On Bonus Eligible

Default Work Shift:

Nights (United States of America)

Hours:

36

Salary range:

$53.00 - $82.08

Schedule:

Full Time

Shift Hours:

12 Hour employee

Department:

Case Management Social Services

Job Objective:

Responsible for facilitating the patient’s hospitalization from preadmission through discharge from the Emergency Department to the community or to an alternative level of care. Interfaces with physicians, nurses, social workers, and other healthcare team members to expedite medically appropriate cost-effective care.

Job Description:

Education: Required: Bachelor of Science in Nursing (BSN) or Master’s degree in Nursing Licensure/Certification: Required: California Registered Nurse (RN) licensure Preferred: Certification in Case Management Experience: Required: Two (2) years of experience as a RN in an acute care or case management setting

Reports To: Clinical Manager or Director Supervises: N/A Ages of Patients: Pediatric, Adolescent, Adult, Geriatric Blood Borne Pathogens: Minimal/ No Potential

Skills, Knowledge, Abilities:

Ability to collect and analyze data to evaluate the quality of necessary medical services and cost of care data and demonstrate cost savings, Exercises a high degree of initiative, judgment, and discretion, Knowledge and ability to use established criteria for medical necessity, including Interqual guidelines, Knowledge of notices of non-coverage/denial letters to patients including Medicare/CMRI, federal and state and guidelines, Knowledge of regulations, standards and legislation (local, state and federal) related to the continuum of care and patient transition, Knowledge of the various health care delivery systems and payer prior approval requirements, Self motivated, self starter, and able to organize efforts around helping clients have a positive experience, Strong clinical and critical thinking skills and ability to establish and carry out complex plans of care for key diagnoses

Essential Responsibilities

1. Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations. 2. Performs pre-admission review of patients admitted from ED; performs inpatient admission review within 24 hours or first working day after admission and concurrent utilization review as necessary to assure payment authorization. 3. Acts as a resource to ED staff and physicians regarding appropriateness of admission, levels of care (including related documentation requirements and observation vs. inpatient requirements), quality of care concerns and criteria/guidelines/protocols utilized in care planning and resource utilization. 4. Gathers sufficient information from and communicates with all relevant sources to facilitate appropriate discharge from ED to appropriate level of care to assure it is done in an accurate, safe, timely and cost effective manner to prevent readmission and/or frequent visits to ED. 5. Assists in triaging calls from other acute care facilities requesting patient transfers to EMC; determines transfer appropriateness by reviewing requested documentation and Interqual level of care criteria and discussions as necessary with admitting physician, supervisors and/or EMC administrators and/or other EMC personnel. 6. Escalates to physician advisor when unable to resolve issues with the attending physician, according to policy and timeframes established. 7. Uses ED tracking system, medical record, and demographic information to identify patients needing CM intervention; identify patients with frequent ED visits; identify patient returning in 48 hours to ED 8. Coordinates patient transfer to the appropriate level of care. Identifies and facilitates resolution of clinical and operational roadblocks to achieve optimal outcomes by identifying alternatives as needed. Communicates resulting decisions to patient/family, physicians and members of healthcare team. 9. Works with ED nurse to ensure evidence based order sets are initiated, when available. Collaborates with other members of the interdisciplinary team to ensure ED relevant evidence based standards of care are met. 10. Facilitates communication regarding the plan of care, promotes collaboration among all members of the healthcare team. 11. Identifies opportunities to improve care/service. Assists in development and implementation of care performance improvement plans based upon analysis of patterns and trends identified from data collection. 12. Organizes, integrates and evaluates the effectiveness of the plan of care and progress toward achievement of desired outcomes. Modifies plan of care as patient/family needs change to accomplish g