Emergency Services Care Coordinator
2 weeks ago
Overview:
The Emergency Department (ED) Care Manager is tasked with establishing, coordinating, and sustaining processes that enhance patient throughput to the most suitable level of care while promoting interdisciplinary collaboration throughout the care continuum in the ED. This role involves working closely with patients and their families, the multidisciplinary team, physicians, community partners, and payers to ensure that the patient's progress and care level are accurately assessed and managed.
The ED Care Manager possesses extensive knowledge and expertise in determining patient status in both inpatient and outpatient environments. They collaborate 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 can benefit patients 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 clinical reviews for admissions, ensuring timely and appropriate care planning.
• Conduct evaluations of anticipated admissions, observation placements, and discharges based on evidence-based criteria for level of care assignment.
• Assess the appropriateness of admissions, distinguishing between observation and inpatient status using MCG and/or InterQual criteria.
• Provide education to ED physicians and nursing staff regarding medical necessity and admission criteria.
• Foster and maintain communication and collaboration with physicians and treatment team members to develop, implement, and assess the patient's care plan.
• Educate providers and staff on documentation requirements and opportunities to support the appropriate level of care and treatment.
• Initiate prior authorization processes when necessary for post-ED referrals and services.
• Leverage financial and insurance resources to maximize patient healthcare benefits.
• Address clinical and utilization issues with 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 contract obligations.
• Escalate unresolved discrepancies with attending physicians to the physician advisor.
• Identify and intervene early with ED patients at risk for readmission.
• Manage high-utilization patients and explore alternatives to frequent ED visits.
• Identify patients who could safely receive standard care treatments at home or in lower-level care settings.
• Plan discharges from the ED for patients not requiring admission, including arrangements for Home Health, DME, and community resources related to social determinants of health.
• Provide education and counseling to patients and families regarding existing health issues and related care.
• Use 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 necessary.
• 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 and competence in the use of prior authorization software are necessary.
• Ability to multitask 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
- 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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