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Emergency Services Care Coordinator
2 months ago
Overview:
The Emergency Department (ED) Care Manager is tasked with establishing, coordinating, and sustaining processes aimed at enhancing patient throughput to the most suitable level of care. This role is pivotal in facilitating interdisciplinary care across the continuum for the ED. The ED Care Manager collaborates closely with patients and their families, multidisciplinary teams, physicians, community partners, and payers to ensure that the patient's progress and level of care are accurately assessed and determined.
The ED Care Manager possesses extensive knowledge and expertise in patient status determination across both inpatient and outpatient settings. They work in conjunction with other care managers, social workers, Patient Access, physicians, and administrative leadership within the ED to ascertain the appropriate level of care. Additionally, the ED Care Manager has a comprehensive understanding of external services and resources that may benefit the patient and initiates referrals as necessary.
Key Responsibilities:
• Uphold the standards of the OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Utilize established criteria to perform patient assessments and admission clinical reviews, ensuring the appropriateness of care settings and timely execution of care plans.
• Conduct reviews of anticipated admissions, placements in Observation status, and discharges using evidence-based criteria for appropriate level of care assignment.
• Assess the appropriateness of admissions, distinguishing between observation and inpatient status utilizing MCG and/or InterQual criteria.
• Provide education to ED physicians and nursing staff regarding medical necessity and admission criteria.
• Initiate and maintain effective communication and collaboration with physicians and other treatment team members to develop, implement, and evaluate patient care plans.
• Educate providers and staff on documentation requirements and opportunities to support the appropriate level of care and treatment provided.
• Initiate prior authorization processes when necessary for post-ED referrals and services.
• Leverage the patient's financial and insurance resources to maximize healthcare benefits.
• Address clinical and utilization issues with physicians and healthcare providers to ensure optimal patient outcomes.
• Communicate with third-party payors and/or review organizations as required, providing necessary information in accordance with regulations and contractual obligations.
• Escalate issues to physician advisors when discrepancies with attending physicians cannot be resolved.
• Identify and intervene early for ED patients at risk of readmission.
• Manage high-utilization patients and explore alternatives to frequent ED visits.
• Identify patients for whom standard care treatments could be safely administered at home or in lower-level care settings.
• Plan discharges from the ED for patients not requiring admission, including arrangements for Home Health, DME, placement, and community resources related to social determinants of health.
• Provide education and counseling to patients and families regarding existing health issues and related care.
• Utilize high-risk screening criteria to facilitate appropriate community and post-ED referrals.
• Anticipate barriers to care delivery and intervene as necessary.
• Coordinate and facilitate patient progression throughout the care continuum.
• Collaborate with all members of the interdisciplinary team to ensure effective care coordination and delivery.
• Assist with the coordination of patient transfers to other inpatient facilities when required.
• Document all care management assessments and interventions in the medical record.
• Familiarity with evidence-based criteria sets is essential.
• Proficiency in computer skills, including Windows, Instant Messaging, and Microsoft Suite (Word, Excel, Outlook) is required.
• Competence in prior authorization functions, including the application of criteria and timelines.
• Ability to analyze clinical information and accurately apply clinical criteria.
• Proficient in medical and managed care terminology.
• Knowledge of and competence in the use of prior authorization software is necessary.
• Ability to multitask effectively between computer, fax, and multi-line phone requests.
Qualifications:
A. Education/Skills
- Associate's Degree in Nursing is required.
- Bachelor's Degree in nursing or a healthcare-related field is preferred.
B. Experience
- A minimum of 3 years of relevant clinical case/care management experience in an acute care setting is required.
C. Licenses, Registrations, or Certifications
- RN License in the state of employment or compact is required.
- Case Manager certification is preferred.
Work Schedule:
Varies
Work Type:
Full Time
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