Care Manager Emergency Room - Case Management - Casual

IRMC•Indiana, PA

About The Position

The Case Manager is responsible for assessing, developing, implementing and monitoring a comprehensive plan of patient care through an interdisciplinary team process to assure that care is timely, medically necessary, and provided in the appropriate setting. Patient insurance eligibility, status and benefit coverage must be determined with each patient encounter. In addition, the Case Manager utilizes medical necessity criteria specific to the managed care/insurance plan to determine appropriateness of admission and continued stay. The Case Manager must assure that the patient moves efficiently through all aspects of care and treatment with optimal utilization of resources and cost. This process is achieved through ongoing case management and communication with all members of the health care team. Strong emphasis is placed on timely, interactive and appropriate communication with the medical staff, medical staff offices and required ancillary departments regarding patient referral, authorization, medical necessity and criteria. The Case Manager also acts as a liaison to pre-post hospital care providers along with community health resources to ensure continuation of patient care. The Case Manager will provide education to patients, families and hospital staff related to provider guidelines, discharge planning and resource information as appropriate. The Case Manager will document and maintain accurate and pertinent information related to each patient. All documentation will be completed through the utilization of a software system via laptop computer. In addition, the Case Manager plays an integral role in the identification of risk, and quality issues through ongoing, concurrent chart review and reporting. The Case Manager must comply with hospital policies and procedures on safety, infection control and performance improvement. Placed in the Emergency Department, the Case Manager will work harmoniously with the Emergency Department staff related to social issues, needs for the patients, and when able to decrease readmissions.

Requirements

Diploma Program, Associate Degree or Bachelor of Science in Nursing or other health related field
2-3 years in medical / surgical nursing
Must be licensed as a Registered Nurse by the PA State Board of Nurse Examiners
Must possess a thorough understanding of third-party payor systems as they relate to utilization management and discharge planning
Motivation for self-direction
Adapts well to continuous change
Ability to exercise supervisory skills and demonstrate leadership
Practical knowledge of the nursing process and continuity of care
Proficient in basic computer skills including word and excel programs

Nice To Haves

Certified case manager preferred
Experience in acute care case management / utilization management, or nursing leadership preferred
ED experience preferred
Case Management experience in acute, Psychiatric or ED preferred
Experience with Medicare/MA/MCO and Third-Party Reimbursement Preferred
Interqual or Milliman experience preferred
Basic knowledge of health care utilization preferred
Case Management Certification Preferred

Responsibilities

Assessing, developing, implementing and monitoring a comprehensive plan of patient care through an interdisciplinary team process
Assuring care is timely, medically necessary, and provided in the appropriate setting
Determining patient insurance eligibility, status and benefit coverage
Utilizing medical necessity criteria specific to the managed care/insurance plan to determine appropriateness of admission and continued stay
Assuring that the patient moves efficiently through all aspects of care and treatment with optimal utilization of resources and cost
Ongoing case management and communication with all members of the health care team
Communication with the medical staff, medical staff offices and required ancillary departments regarding patient referral, authorization, medical necessity and criteria
Acting as a liaison to pre-post hospital care providers along with community health resources to ensure continuation of patient care
Providing education to patients, families and hospital staff related to provider guidelines, discharge planning and resource information as appropriate
Documenting and maintaining accurate and pertinent information related to each patient
Identification of risk, and quality issues through ongoing, concurrent chart review and reporting
Complying with hospital policies and procedures on safety, infection control and performance improvement
Working harmoniously with the Emergency Department staff related to social issues, needs for the patients, and when able to decrease readmissions