The RN ED Case Manager assesses, coordinates, and facilitates patient progression through the continuum of care efficiently by assessing pre-admission needs and post-discharge requirements through timely communication with the healthcare team and patient/family. Responsibilities include using the ED tracking system to identify admissions, screening patients for payer source and level of care, and consulting with providers to determine appropriate status like observation versus inpatient.
Requirements summary
Candidates must have a minimum of 3-5 years of acute care case management experience, including demonstrated utilization review skills and strong critical thinking abilities for safe patient transitions. A BSN from an accredited school of nursing is required, along with a current Massachusetts RN license; CCM or ACMA certification is preferred.
bachelor degreeInterpersonal SkillsCase ManagementCommunicationProblem SolvingComputer SkillsRegulatory ReportingCritical ThinkingDischarge PlanningAnalytical AbilityUtilization ReviewInsurance RegulationsPlan Of Care ModificationMedical Management CriteriaCMS/Medicaid KnowledgeED Tracking SystemLevel Of Care Designation
Job description
Scheduled Weekly Hours
40 - $20,000 sign on bonus 40 hour position with every other weekend rotation 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.
Education/Training:
Graduate of an accredited school of nursing:
BSN/MSN preferred
Licenses/Certification:
RN with current Massachusetts license required
CCM (Certified Case Manager) Preferred
ACMA (Accredited
Case
Manager)
Preferred
Required
Qualifications and
Skills: Minimum 3-5 years of experience in acute care case management, 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
Preferred
Qualifications and
Skills: Experience in
Cerner a plus
Denials management a plus
Essential
Job
Functions: 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
Other duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
AGE
AND
Diversity
RELATED
CRITERIA: Consistently treats patients, colleagues and visitors with the dignity and respect, while being sensitive to the differing needs of all age groups, backgrounds, characteristics and cultures.
ABILITY
TO
FULFILL
JOB
EXPECTATIONS: Must have the ability to the perform essential functions of the position, including required work hours, locations and physical demands, without posing a direct threat to the health and safety of themselves or other individuals in the work place, and with or without reasonable accommodation.
Physical
DEMANDS: Ability to sit (may be for long periods of time), stand, reach and lift up to 15 pounds Ability to readily travel to units/departments across the system as needed. Ability to communicate effectively with all stakeholders, in person as well as via telephone and electronically Ability to interact directly with patients, with potential for direct exposure to patient care activities Ability to document and use trackers, analyze charts and coordinate services within the electronic health record Ability to advocate for patients both internally and external to the system Ability to attend and participate professionally in meetings with Hospital leaders, physicians, patients and families -
Salary Range
$87,015.12-$135,323.52 -
Salary Range
Details The pay range displayed on each job posting reflects the anticipated range for new hires. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set, and education. This is not inclusive of the value Sturdy Health’s benefits package (if applicable), which includes among other benefits, healthcare/dental/vision and retirement. For annual salaries this is based on full-time employment. - Sturdy Memorial Hospital is an equal employment opportunity employer. There is no discrimination because of race, color, creed, age, gender, sexual orientation, national origin, veteran status or disability. Current Sturdy Health Employees – Click here to apply for open positions. Our Work Experience is the combination of everything that’s unique about our culture, our core values, our company meetings, our commitment to success, our recognition programs, but most importantly, it’s our people. Our employees are self-disciplined, hardworking, curious, trustworthy, humble and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in our area. Are you interested in a position at Sturdy Health with Dana-Farber Cancer Institute? Click here to apply!
