ED Clinical Care Coordinator (ED C3) - Care Navigation

Montage Health•Monterey, CA

22d•$73 - $98

About The Position

The ED Clinical Care Coordinator (ED C3) is the Emergency Department’s clinical spoke of the Care Navigation Hub. The role provides early visibility into anticipated admissions to support proactive bed planning, ensures admissions are appropriately statused, and helps prevent unnecessary admissions. The coordinator monitors ED demand, boarding, patient progression, and barriers to timely care, working with physicians, nurses, the Hub, and interdisciplinary partners to support appropriate placement and disposition. The position provides clinical guidance on inpatient admission, observation, outpatient treatment, discharge, and alternative levels of care. It supports appropriate utilization of hospital resources, initiates physician peer review when appropriate, and helps identify clinical, functional, social, and other needs that affect safe transitions. The coordinator also supports complex and high-risk patients, coordinates care for frequent ED utilizers, helps address boarding and transfer barriers, and provides clinical direction to the ED C3a to ensure continuity between the ED plan and coordinated services. This is a regular 0.9 FTE position with variable 12-hour day shifts and rotating weekends and holidays. The listed pay range is $73.13 to $97.81 per hour, based on applicable experience. Evening and night shift differentials are listed as $5.50 and $8.00 per hour, respectively.

Requirements

State of California RN license required.
American Heart Association Healthcare Provider BLS required.
Demonstrated clinical experience in a hospital or Emergency Department setting.
Experience evaluating patient diagnoses, clinical conditions, treatment plans, and outcomes using established clinical, utilization, and regulatory criteria.
Experience assessing patient status and level of care, including inpatient, observation, and discharge considerations.
Experience collaborating with physicians, nurses, Case Management, Social Work, and other interdisciplinary teams to coordinate care and facilitate timely disposition.
Experience identifying and resolving barriers to admission, patient progression, discharge, transfer, and transition of care.
Experience communicating complex clinical and utilization information to patients, families, physicians, interdisciplinary teams, and other stakeholders.
Experience managing multiple priorities in a fast-paced environment while maintaining organization, sound judgment, confidentiality, and professional relationships.
Must pass orientation and the initial competency assessment before independently assigning patients requiring the applicable skill, and must complete and pass all annual competencies.

Nice To Haves

Minimum of five years of current acute care hospital experience is preferred.
Experience in acute care case management, utilization management, care coordination, or a related clinical role.
Experience applying knowledge of Medicare, Medi-Cal, commercial insurance, and applicable state and federal requirements related to patient status, reimbursement, and healthcare resource utilization.
Experience coordinating or connecting patients with post-acute, community, behavioral health, and other healthcare resources.
Bachelor’s degree in nursing preferred.
Acute hospital case management experience.
Utilization Management experience.
Emergency Department clinical experience.
Knowledge of local healthcare and community resources.
Knowledge of Medicare, Medi-Cal, commercial insurance, and applicable state and federal healthcare requirements.

Responsibilities

Maintain awareness of ED demand, boarding volume, anticipated admissions, and barriers to patient progression as the ED clinical spoke of the Care Navigation Hub.
Work with the Care Navigation Hub to prevent boarders and recommend appropriate bed placement based on current capacity constraints.
Work with ED physicians, charge nurses, and interdisciplinary staff to identify anticipated admissions, observation patients, discharges, and care needs.
Track ED patient flow and throughput, intervene or escalate barriers, and collaborate to facilitate timely and appropriate patient placement and disposition.
Partner with ancillary services to identify and prevent inappropriate ED testing and facilitate outpatient treatment.
Update and confirm bed requests, ensuring accurate patient information and appropriate placement based on clinical needs, patient attributes, and required resources.
Identify and escalate barriers to admission, transfer, placement, progression, and discharge.
Advise physicians on disposition, patient status determination, and cases that may not meet inpatient admission criteria.
Consult with and educate medical staff regarding patient status, bed placement, payer requirements, and appropriate utilization of hospital resources.
Initiate the physician peer review process when appropriate.
Identify patients who may benefit from alternative treatment or referral pathways and determine appropriate clinical referrals or interdisciplinary resources.
Collaborate with physicians and interdisciplinary teams to ensure disposition decisions are clinically appropriate and aligned with patient needs.
Initiate discharge and transition planning at ED presentation when needs are anticipated.
Identify clinical, functional, social, equipment, medication, transportation, caregiver, and post-acute needs that may affect safe disposition.
Develop or facilitate discharge plans with physicians, nursing, the ED C3a, Social Work, and other interdisciplinary partners.
Direct the ED C3a or appropriate interdisciplinary resource to facilitate referrals and follow-up for patients needing additional services or resources.
Address or escalate barriers that may prevent safe or timely discharge.
Identify patients at increased risk for readmission, repeat ED utilization, care fragmentation, or poor transition outcomes.
Coordinate care planning for frequent ED utilizers and medically complex patients with the interdisciplinary team and established Care Navigation programs.
Identify barriers to ongoing care and determine appropriate clinical and community resources.
Continue Care Navigation activities for admitted patients boarding in the ED, including identifying and escalating barriers to inpatient placement and progression.
Identify patient-specific placement needs, such as oxygen, sitter requirements, isolation, equipment, or specialty services.
Coordinate with the Care Navigation Hub and inpatient teams to resolve placement barriers.
Coordinate interfacility EMTALA transfers with physicians, transfer centers, receiving facilities, and other stakeholders.
Escalate delays related to diagnostics, consultations, transportation, environmental services, physician decision-making, bed availability, or other patient-flow barriers.
Collaborate with inpatient Clinical Care Coordinators, Utilization Management, Social Work, physician advisors, and community partners.
Delegate or direct appropriate non-clinical coordination activities to the ED C3a based on the established clinical plan.
Provide clinical direction and clarification to the ED C3a regarding patient needs, referrals, and escalation of barriers.
Review unresolved barriers identified by the ED C3a and determine appropriate clinical or interdisciplinary intervention.
Ensure continuity between the ED clinical plan and services coordinated by the C3a.