Emergency Department Care Manager
1 week ago
The Emergency Department Care Manager plays a vital role in ensuring the efficient and effective care of patients in the emergency department. This position requires a strong understanding of clinical criteria and the ability to collaborate with multidisciplinary teams to determine the appropriate level of care for patients.
Key Responsibilities- Conduct patient assessments and admission clinical reviews to ensure appropriateness of setting and timely implementation of the plan of care.
- Review anticipated admissions, placements in Observation status, and discharges using evidence-based criteria sets.
- Screen appropriateness of admission, including observation versus inpatient status, utilizing MCG and/or InterQual criteria.
- Initiate and maintain communication and collaboration with physicians and other members of the treatment team to develop, implement, and evaluate the plan of care for patients.
- Provide education to providers and staff on documentation needs and opportunities to support the appropriate level of care and the treatment being provided.
- Initiate prior authorization processes when indicated for post-ED referrals and services.
- Utilize financial and insurance resources of patients to maximize their healthcare benefits.
- Intervene with physicians and other healthcare providers regarding clinical and utilization issues to ensure optimal patient outcomes.
- Communicate with third-party payors and/or review organizations as necessary and provide information to both government and private payors in accordance with regulation and/or contract requirements.
- Escalate to physician advisors when unable to resolve discrepancies with attending physicians.
- Provide early identification and intervention of ED patients at risk for readmission.
- Manage high-utilization patients and work to find alternatives for care to frequent ED visits.
- Identify patients for whom standard of care treatments could be safely rendered at home or other lower levels of care settings.
- Plan for discharges from the ED for patients who do not require admission, including arranging for Home Health, DME, placement, and community resources as they relate to social determinants of health.
- Provide patient and family education and counseling about existing health problems related to care.
- Utilize high-risk screening criteria to make appropriate community and post-ED referrals.
- Anticipate barriers/variances to the delivery of care and intervene as necessary.
- Coordinate and facilitate patient progression throughout the continuum.
- Collaborate with all members of the interdisciplinary team to facilitate appropriate care coordination and care delivery.
- May assist with coordination of patient transfers to other inpatient facilities when indicated.
- Document all CM assessments and interventions in the medical record.
- Associate's Degree in Nursing required.
- Bachelor's Degree in nursing or healthcare-related field preferred.
- 3+ years of relevant clinical case/care management experience in the acute care setting required.
- RN License in state of employment or compact.
- Case Manager certification preferred.
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Emergency Department Care Manager
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Emergency Department Care Manager
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