RN Case Manager (ED)

Sturdy Memorial Hospital•Attleboro, MA

20h•$70,329 - $108,646

About The Position

Working in collaboration with the patient/family/legal representative, social workers, physicians, and interdisciplinary team, the RN ED case manager is accountable for assessing, coordinating and facilitating patient progression through the continuum of care in an efficient, cost effective manner. The RN ED Case Manager must achieve this through early assessment of pre-admission level of care, post hospital discharge needs, review of available resource and timely, focused communication with the healthcare team and patient/family/legal representative.

Requirements

Minimum 3-5 years acute care case management experience, with demonstrated skills in utilization review
Demonstrated ability to use critical thinking and problem solving skills in facilitating safe and timely patient transitions of care
Excellent communication skills and positive interpersonal dynamic in working with a variety of stakeholders across the care continuum
Solid knowledge of all insurance plan regulations including CMS/Medicaid to ensure compliance with all required processes and documentation
Ability to garner and utilize information effectively to develop and modify patient plan of care
Strong analytical ability to interpret patient-related information, evaluate appropriateness of continued stay and/or need for ancillary services, and to reassess discharge planning needs based on daily assessment.
Ability to successfully utilize industry accepted utilization and or medical management criteria in patient status decision making
Self-starter able to function independently within the scope of position and licensure, as well as department policies and established goals
Excellent computer skills to accurately document requisite information to support patient status and medical necessity
RN with current Massachusetts license required
Ability to effectively communicate to all age levels served within the scope of the position/assigned areas.
Must have the ability to perform the essential functions of the position without posing a direct threat to the health and safety of themselves or other individuals in the workplace, with or without a reasonable accommodation.

Nice To Haves

Experience in Cerner a plus
Denials management a plus
CCM (Certified Case Manager) Preferred
ACMA (Accredited Case Manager) Preferred

Responsibilities

Use ED tracking system, medical record, and on-going communication with ED providers and team to identify potential admissions or alternative disposition as appropriate.
Screen all ED patients for potential for admission to ascertain payer source and appropriate level of care designation.
Collaborate with providers to determine, assign, and order appropriate level of care (LOC) designation and ensure medical record documentation.
Determination of appropriate admission status (observation vs. inpatient) using standardized criteria; providing resources and education to the healthcare team.
Initiate and/or complete initial review
Communicate LOC and/or length of stay (LOS) concerns to case management team for follow-up the next morning.
Consults with and takes referrals from ED providers, nurses, hospitalists, other care team members, ED patients, and families.
Reviews all consults placed from ISAR screening tool and assists social worker with completion of these consults in order to provide patients with needed home referrals or rehab/SNF placement.
Responds to outside patient/family calls for follow-up care coordination questions.
Uses ED tracking system, medical record, and demographic information to identify high-risk or any patient needing CM intervention.
Identify patients with frequent ED visits utilizing the EHR and EDIE collective medical group notifications.
Identify patient returning in 48 hours to ED or hospitalization within 30 days.
Assess ED patients referred and/or identified through case finding for options other than acute hospital admission when appropriate:
Screen and refer to acute rehabilitation, long-term acute care hospitals, and nursing homes for admission directly from the ED.
Screen and refer patients for whom treatments could be safely rendered at home with services (i.e., IV antibiotics, low molecular weight heparin injections, wound care, etc.)
Consult additional services to complete a safe and effective discharge plan, including physical therapy, social services, palliative care, interpreters, homeless advocates, patient financial services, behavioral health, etc.
Communicate discharge planning information and/or concerns to team for follow-up the next morning.
Initiate referral to long term care facilities, per patient/caregiver requests, following established referral procedures, initiates a PASRR screen, and ensures appropriate continuity of care information is provided to facility.
Mandatory reporting to regulatory agencies
Provide additional community resources and support