RN Case Manager , Point of Entry 24 hours, Evenings
About The Position
In collaboration with other members of the healthcare team, the Point of Entry/Emergency Department Case Manager (POE/ED CM) is accountable for coordination and facilitation of the management of care for ED patients, both inpatient and observation. The POE/ED CM manages patient flow through the ED by evaluating incoming patients and assisting in determining appropriate discharge disposition (Home, Post-acute Services, Inpatient, or Observation). This includes early assessment of discharge needs and communication among healthcare team members and family/caregivers. The POE/ED CM collaborates with admitting teams to ensure correct initial admission status using InterQual criteria.
Requirements
- Bachelor of Science in Nursing
- Current Massachusetts RN license
- Minimum 3 years of medical, surgical, ICU, or ED nursing experience
- Demonstrated sound judgment and knowledge of medical care and support services
- Excellent interpersonal and communication skills
- Analytical ability to evaluate patient care needs and service appropriateness
Nice To Haves
- CCM certification
- 3–5 years of hospital-based case management
- Emergency department experience
- Utilization review experience
Responsibilities
- Reviews all ED patients promptly.
- Reviews all admitted patients within one hour of admission or before admitting orders are placed.
- Intervenes early for patients with progressive conditions or complex needs.
- Ensures communication among MSW, CM, and ED care team.
- Completes and documents initial discharge planning assessments.
- Refers complex or high-utilizer patients for MSW psychosocial assessment.
- Identifies and documents readmissions for follow-up.
- Completes admission reviews using InterQual criteria.
- Collaborates with providers to resolve discrepancies in medical necessity.
- Documents clinical reviews in Meditech per standards.
- Executes discharge plans in collaboration with ED and admitting physicians.
- Prioritizes discharges requiring post-acute care arrangements.
- Arranges services such as Home Health, DME, SNF, rehab, and medications.
- Escalates unresolved cases to appropriate leadership.
- Follows formal escalation processes for utilization and level of care issues.
- Documents avoidable delays for boarded ED patients daily.
- Applies knowledge of growth and development stages to patient care.
- Demonstrates age-appropriate communication and support.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
