Emergency Department Case Manager (RN)

Baptist Healthcare System•Corbin, KY

7d•Onsite

About The Position

The Case Management Department coordinates patient care across the healthcare continuum to promote quality outcomes, efficient use of resources, and a seamless patient experience. Case managers work collaboratively with physicians, nurses, social workers, patients, families, and community partners to assess patient needs, develop care plans, coordinate services, and facilitate safe transitions of care. The Emergency Department (ED) Registered Nurse Case Manager position is responsible for an initial medical necessity review for admitted patients and transition planning. This individual will use established MCG criteria to assess both the appropriate admission status (inpatient or observation) and level of care. This position will provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. A high level of communication with other members of the interdisciplinary team will be required to coordinate the continuum of care activities, ensuring optimum utilization of resources, quality outcomes related to transition of care service delivery and compliance with external review agencies’ requirements. The individual in this role should support an environment of care focused on evidence-based healing and wellness.

Requirements

Associate Degree in Nursing
Three years of nursing experience required
Current Registered Nurse (RN) license in the state of practice.
Basic Life Support (BLS) certification from the American Heart Association (AHA) within 30 days of hire.

Nice To Haves

Bachelor's Degree preferred.
Case Management and Utilization Management experience preferred.

Responsibilities

Coordinates patient progression, care transitions, and discharge planning across the continuum of care.
Completes patient assessments, utilization reviews, and high-risk screenings to identify care needs and ensure appropriate level of care.
Develops, implements, and evaluates individualized plans of care in collaboration with physicians, nursing, social work, and interdisciplinary teams.
Arranges post-acute services including home health, hospice, skilled nursing, durable medical equipment, transportation, community resources, and follow-up care.
Educates patients and families on discharge planning, available resources, financial considerations, and self-management.
Facilitates safe, timely, and cost-effective transitions of care while promoting quality outcomes and reducing readmissions.
Coordinates communication among patients, families, providers, payers, and care teams to ensure continuity of care.
Utilizes clinical criteria, case management tools, and documentation systems to support utilization management, regulatory compliance, and quality initiatives.
Advocates for patients while balancing clinical, financial, and organizational goals through effective care coordination and resource utilization.
Performs other duties as assigned.