RN Case Manager - Emergency Department

Trinity Health • Philadelphia, PA

1d • Onsite

About The Position

Under the general supervision of the Director of Care Coordination, the Emergency Department Care Manager assists physicians and the interdisciplinary team in facilitating the entry of patients into the appropriate level of care by utilizing InterQual criteria. As a RN Case Manager, you will: Reduces unnecessary admissions to the acute care hospital. Has accountability for assigning correct levels of care (Outpatient Observation vs. Inpatient Admission), attention to the issues presented by readmissions and recommending options for safe discharge. Coordinates all non-elective point of entry admissions (including direct admissions and SPU) and facilitates timely throughput of emergency room patients to ensure the safe delivery of services to the patient at the most appropriate level of care. Responsible for identifying community and other resources that are necessary for each individual patient and matches specific needs for continued care that are acceptable to the patient. Identifies services that require authorization and collaborates with payers to obtain needed authorizations for services. Ensures patient has a primary care physician follow-up. Collaborates with the ED healthcare team to determine the treatment plan, while observing quality and patient safety parameters, LOS, readmissions, denials and appeals.
About us: Nazareth Hospital serves Northeast Philadelphia and the surrounding region. With over 160 inpatient beds and many outpatient services, Nazareth Hospital has a broad range of specialties to meet patients’ health care needs. Nazareth Hospital offers outstanding diagnostic, medical, surgical and therapeutic care with state-of-the-art technology. With the dedication of 1,200 employees and 350+ physicians and specialists, Nazareth Hospital treats patients and their families with respect and compassion while providing health care services in response to the changing needs of our community.
Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law. Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. Together, we’re 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services. Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs. For more information, visit http://www.trinity-health.org. You can also follow Trinity Health on LinkedIn.

Requirements

• Bachelor's degree in nursing required
• Active PA RN License required
• Three (3) years of utilization management or case management experience, including emphasis on discharge planning

Nice To Haves

• Case Management certification from an accredited organization preferred

Responsibilities

• Assists physicians and the interdisciplinary team in facilitating the entry of patients into the appropriate level of care by utilizing InterQual criteria
• Reduces unnecessary admissions to the acute care hospital
• Has accountability for assigning correct levels of care (Outpatient Observation vs. Inpatient Admission), attention to the issues presented by readmissions and recommending options for safe discharge
• Coordinates all non-elective point of entry admissions (including direct admissions and SPU) and facilitates timely throughput of emergency room patients to ensure the safe delivery of services to the patient at the most appropriate level of care
• Responsible for identifying community and other resources that are necessary for each individual patient and matches specific needs for continued care that are acceptable to the patient
• Identifies services that require authorization and collaborates with payers to obtain needed authorizations for services
• Ensures patient has a primary care physician follow-up
• Collaborates with the ED healthcare team to determine the treatment plan, while observing quality and patient safety parameters, LOS, readmissions, denials and appeals

Benefits

• Comprehensive benefit packages, including medical, dental, vision, mental health, paid time off, 403B, education assistance and voluntary benefits (pet insurance, accident insurance, hospital indemnity and others) available from the first day of employment.
• Work/Life balance with flexible schedules.
• Free onsite parking.
• Referral Rewards Program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level