ED Admissions Case Manager - Utilization & Care Coordination

Northeast Georgia Health System; Gainesville (FL); On-site; USD 68,000 - 90,000; Full time

Job summary

The ED Admissions Case Manager at Northeast Georgia Health System evaluates and screens ED admissions using InterQual/MCG guidelines to ensure appropriate status and level of care based on physician documentation.

This role partners with physicians, patients, families and the care team to implement care plans, coordinate transfers, and support timely discharges while maintaining HIPAA and regulatory compliance.

Qualifications

• Active GA RN licensure
• Associate degree in Nursing (ADN) required
• 1–2 years in utilization management or case management
• 3–5 years in direct patient care or case management

Responsibilities

• Determine if patients meet medical necessity criteria for admission/transfer using InterQual/MCG
• Coordinate entry into NGMC’s acute beds and communicate with physicians
• Refer cases to physician advisors and obtain status orders
• Collaborate with care team to ensure appropriate length of stay and discharge planning
• Maintain HIPAA compliance and protect patient confidentiality
• Support process improvement within the Care Coordination area
• Provide discharge planning and post-acute transition coordination

Skills

Clinical knowledge

Critical thinking

Communication

Computer literacy

HIPAA compliance

Education

Associate degree in Nursing

Bachelor's degree preferred

Tools

InterQual/MCG Guidelines

Job description

The ED Admissions Case Manager at Northeast Georgia Health System evaluates and screens ED admissions using InterQual/MCG guidelines to ensure appropriate status and level of care based on physician documentation.

This role partners with physicians, patients, families and the care team to implement care plans, coordinate transfers, and support timely discharges while maintaining HIPAA and regulatory compliance.