RN-ED Case Manager
7 days ago
We are seeking a skilled RN-ED Case Manager to join our team at Eisenhower Health. The successful candidate will be 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.
Key Responsibilities- Perform pre-admission review of patients admitted from ED, and inpatient admission review within 24 hours or first working day after admission, and concurrent utilization review as necessary to assure payment authorization.
- Act as a resource to ED staff and physicians regarding appropriateness of admission, levels of care, quality of care concerns, and criteria/guidelines/protocols utilized in care planning and resource utilization.
- Gather sufficient information from and communicate 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.
- Assist in triaging calls from other acute care facilities requesting patient transfers to EMC, determine transfer appropriateness by reviewing requested documentation and Interqual level of care criteria, and discuss as necessary with admitting physician, supervisors, and/or EMC administrators and/or other EMC personnel.
- Escalate to physician advisor when unable to resolve issues with the attending physician, according to policy and timeframes established.
- Use ED tracking system, medical record, and demographic information to identify patients needing CM intervention, identify patients with frequent ED visits, and identify patient returning in 48 hours to ED.
- Coordinate patient transfer to the appropriate level of care, identify and facilitate resolution of clinical and operational roadblocks to achieve optimal outcomes by identifying alternatives as needed, communicate resulting decisions to patient/family, physicians, and members of healthcare team.
- Work with ED nurse to ensure evidence-based order sets are initiated, when available, collaborate with other members of the interdisciplinary team to ensure ED relevant evidence-based standards of care are met.
- Facilitate communication regarding the plan of care, promote collaboration among all members of the healthcare team, identify opportunities to improve care/service, and assist in development and implementation of care performance improvement plans based upon analysis of patterns and trends identified from data collection.
- Organize, integrate, and evaluate the effectiveness of the plan of care and progress toward achievement of desired outcomes, modify plan of care as patient/family needs change to accomplish goals established in the plan of care, communicate plan of care, including changes and issues related to plan of care to patient/family, physicians, and other members of the healthcare team.
- Facilitate communication and translation of above-stated information to inpatient Care Coordinators for patients who will be admitted to inpatient or observation, facilitate the initiation of diagnostic services, treatment planning, and therapeutic treatment while patient is present in the emergency department of admitted patients.
- Document all care management assessments and interventions, insert most current discharge planning documentation into medical record, demonstrate understanding of payer prior approval requirements and the various healthcare delivery systems and payer plan contracts, communicate with third-party payers and/or review organization as necessary, and provide information to federal, state, and private payers and/or review organizations so that determinations regarding benefits and coverage may be made.
- Comply with regulations, standards, and legislation (local, state, and federal) related to the continuum of care and patient transition, maintain internal and external resources available to meet patient's needs, share this information with peers and other members of the healthcare team, assess ED patients and identify options other than acute hospital admission when appropriate, screen and refer to acute rehabilitation, long-term acute care hospitals, and nursing homes for admission directly from the ED, screen and refer patients to clinics after initial exam, screen and refer patients for whom treatments could be safely rendered at home with services.
- Coordinate clinical and financial discharge planning needs as necessary so that a smooth transition from the acute outpatient care setting to the community setting is ensured and inappropriate readmission is averted, refer to Social Work for complex psychosocial and discharge planning issues and ensure appropriate follow-up, consult with other members of the interdisciplinary team (physical therapy, pharmacy, etc.) to provide safe discharge as appropriate, identify potential opportunities for cost savings, evaluate services provided, timeliness, and costs, and assist in action plan development and implementation as requested/appropriate.
Eisenhower Health is an equal opportunity employer and welcomes applications from diverse candidates.
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