ED Care Manager
About The Position
CentraState Medical Center is seeking an Emergency Department Nurse Care Manager to establish, coordinate, and maintain processes that optimize patient throughput to the most appropriate level of care and facilitate interdisciplinary care across the ED continuum. The role collaborates with patients and families, the multidisciplinary team, physicians, community resources, and payers to determine the appropriate level of care for emergency and inpatient encounters and promote efficient, cost-effective care delivery. The position evaluates medical necessity and admission criteria, supports patient flow and discharge planning, helps prevent readmissions, and connects patients with appropriate social work, outpatient, home health, and community resources. It also maintains knowledge of relevant regulations and care-continuum resources, and works with the healthcare team to address potential risk management or quality issues.
Requirements
- BSN or bachelor's degree in a related field, or current enrollment in a BSN or related bachelor's degree program.
- Prior clinical experience in the care and management of hospitalized patients.
- RN license required in New Jersey.
- Excellent communication, negotiation, and conflict-resolution skills.
- Data and computer skills.
- Knowledge of relevant state utilization review and appeals requirements.
- Rapid-cycle change or clinical performance-improvement expertise.
Nice To Haves
- Experience in acute-care utilization.
- Utilization review or case management training from a professional Case Management organization.
- Case Management certification.
Responsibilities
- Complete initial medical necessity reviews for ED patients with potential admissions and work with providers to determine the appropriate level of care.
- Document in accordance with established policies and procedures.
- Educate ED physicians and nurses about medical necessity and admission criteria.
- Use Social Work screening criteria to refer patients and families with complex psychosocial needs, discharge-planning issues, or continuing-care needs to social services.
- Collaborate with medical staff to recommend outpatient, home health, and community-agency referrals to help prevent readmissions.
- Provide post-discharge follow-up by conducting or delegating telephone evaluations of discharge plans.
- Work with the team to establish interventions for patients who frequently use services.
- Expedite diagnostic testing needed to determine patient disposition, offer alternatives to admission when appropriate, and participate in boarder rounds to assess disposition changes.
- Initiate discharge planning by screening for social determinants of health and completing initial discharge-planning assessments for patients admitted through the ED.
- Maintain knowledge of federal, state, and other regulatory requirements, including The Joint Commission, CMS, Medicare, observation-status rules, the 2 Midnight Rule, and Medicare Inpatient Only Procedures.
- Maintain knowledge of care-continuum resources and educate patients, families, and the healthcare team about care progression, service utilization, appropriate level of care, and safe transitions.
- Identify potential risk management or quality issues and work with the healthcare team to resolve them or refer them through the Chain of Command to an appropriate resource or committee.
- Perform other duties as assigned by management.
Benefits
- Medical, dental, vision, and prescription coverage for team members working 30 hours per week or above.
- Life and AD&D insurance.
- Long-term disability, with options to supplement.
- 403(b) retirement plan with employer match.
- 401(a) retirement plan with employer contribution.
- Paid time off (PTO).
- Tuition reimbursement and tuition assistance.
- Well-Being Rewards.
- Employee Assistance Program (EAP).
- Fertility coverage and Healthy Pregnancy Program.
- Flexible spending and commuter accounts.
- Pet, home and auto, identity theft, and legal insurance.
- Growth opportunities and workforce development initiatives.
- Continuing education and onsite training.
- Concierge services with work and family benefits.
- Work/life balance initiatives and career advancement opportunities.
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What This Job Offers
Job Type
Full-time
