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Emergency Services Care Coordinator
2 months ago
Position Overview:
The Emergency Department (ED) Care Manager is tasked with the vital role of establishing, coordinating, and overseeing processes that enhance patient throughput to the most suitable level of care. This position emphasizes the importance of interdisciplinary collaboration throughout the continuum of care within the ED. The ED Care Manager works closely with patients and their families, the multidisciplinary team, physicians, community partners, and payers to ensure that the patient's care trajectory and level of service are accurately assessed and managed.
Key Responsibilities:
- Demonstrates proficiency in the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
- Utilizes established criteria to perform patient assessments and clinical reviews for admissions, ensuring the appropriateness of care settings and timely execution of care plans.
- Conducts reviews of anticipated admissions and discharges, applying evidence-based criteria to assign the appropriate level of care.
- Educates ED staff on medical necessity and admission criteria to enhance understanding and compliance.
- Facilitates ongoing communication and collaboration with physicians and treatment team members to develop, implement, and evaluate patient care plans.
- Provides guidance to providers and staff regarding documentation requirements to support the appropriate level of care.
- Initiates prior authorization processes for post-ED referrals and services when necessary.
- Maximizes patient healthcare benefits by effectively utilizing financial and insurance resources.
- Addresses clinical and utilization issues with healthcare providers to ensure optimal patient outcomes.
- Engages with third-party payors and review organizations as required, ensuring compliance with regulations and contractual obligations.
- Identifies and intervenes for ED patients at risk for readmission, managing high-utilization cases to find alternative care solutions.
- Plans discharges for patients not requiring admission, coordinating home health services, durable medical equipment, and community resources related to social determinants of health.
- Educates patients and families on health conditions and care options available to them.
- Employs high-risk screening criteria to facilitate appropriate community and post-ED referrals.
- Anticipates and addresses barriers to care delivery as necessary.
- Coordinates patient progression throughout the care continuum, collaborating with all interdisciplinary team members to ensure effective care coordination.
- Documents all assessments and interventions in the medical record accurately.
Qualifications:
- Associate's Degree in Nursing is required; a Bachelor's Degree in nursing or a healthcare-related field is preferred.
- A minimum of 3 years of relevant clinical case or care management experience in an acute care environment is required.
- Current RN License in the state of employment or compact is mandatory; Case Manager certification is preferred.
Work Schedule:
Varies
Work Type:
Full Time
