ER Case Manager
- El Paso, TX
Provides overall coordination in the delivery of medical services and discharge planning for a specified patient population. Performs concurrent and retrospective review of patient medical records for purposes of utilization review, compliance with requirements of external review agencies including governmental and non-governmental payers and quality assurance agencies. Promotes a cooperative and supportive relationship as liaison with patient, family, facility staff, physicians, funding representatives and community agencies. Ensures continuity in the handoff of patient clinical information from the hospital to other involved healthcare entities. The duties of the acute care Case Manager may be performed as in the integrated or triad model.
POPULATION SERVED: All patients admitted to the hospital, emergency room, or outpatient areas and their families and/or caregivers.
1. Financial Assessment and Coordination
2. Treatment Planning and Coordination of Services
3. Utilization Review, Quality and Compliance Monitoring
4. Discharge Planning and Continuity of Care
5. General Dutiesa. Attends twice weekly outlier meeting with Case Management Director and Medicaid Eligibility Vendor personnel to review observation admissions, extended LOS, unfunded and underfunded, and anticipated difficult discharges.b. Attends and actively participates in monthly staff meetings, and attends called departmental meetings when necessary.c. Attends and participates in facility committees, employee forums and departmental meetings as requested.d. Actively utilizes and complies with facility principles of good communication and customer service standards, including use of AIDET as developed by the department.e. Maintains compliance with required licensure, ethics and compliance training, annual mandatory TB screening and mandatory education as required.f. Prepares and presents inservice and training programs as requested.g. Performs other duties as required.
REQUIRED LICENSURE/CERTIFICATIONS: Current RN licensure; ADN required, BSN required or enrolled within 6 months of hire. REQUIRED EDUCATION/EXPERIENCE: (Required) Registered Nurse with clinically focused work history in Emergency room and case management. PREFERRED EDUCATION, LICENSURE, CERTIFICATION, EXPERIENCE, SKILLS, KNOWLEDGE ANDABILITIES: Prefer three-five years clinical experience within an acute health care setting with recent work history in acute care case management role or related health care experience. Working knowledge of case management philosophy/process/role, needs assessment, principles of utilization review/quality assurance, use of InterQual® or otherclinical decision support criteria, discharge planning, and reimbursement structures (i.e. Government and non-governmental payers).Ability to read, analyze and comprehend complex clinical and financial data and its application to level of care criteria and discharge options; strong, broad-based clinical knowledge and understanding of pathology/physiology of disease processes; excellent critical thinking skills; assertive personality traits to facilitate ongoing physician communication; organize, prioritize and manage time efficiently. Computer literacy and familiarity with the operation of basic office equipment. Must be able to communicate effectively with a wide range of hospital personnel, physicians, patients/family members within various socioeconomic groups and representatives of varied outside agencies. Ability to communicate effectively with and know the age-specific needs of patients of adolescent, adult and geriatric age.