ED Care Manager

CentraState Healthcare System, Inc.; United States; On-site; USD 94,000 - 159,000; Full time

Benefits offered by this job

Medical coverage

Well-being rewards

Tuition reimbursement

PTO

retirement plans

Job summary

CentraState Healthcare System, based in Freehold, New Jersey, is seeking an Emergency Department (ED) Nurse Care Manager to optimize patient throughput and coordinate interdisciplinary care across the ED continuum.

The role partners with patients, families, physicians and payers to determine appropriate levels of care, supports discharge planning, and drives efficient, cost-effective care delivery in a Magnet-recognized, Great Place to Work-Certified organization.

Qualifications

• BSN or related field required or current enrollment in BSN program
• RN license in New Jersey required
• Experience in acute care utilization; case management training preferred
• Case Management certification preferred
• Excellent communication, negotiation, and conflict resolution skills
• Data and computer skills
• Knowledge of utilization review and appeals requirements
• Rapid cycle change or clinical performance improvement expertise

Responsibilities

• Complete initial medical necessity review and determine level of care with policy adherence
• Refer high risk patients to social services and coordinate complex discharge planning
• Collaborate to recommend post-discharge referrals and follow-up care
• Support patient flow by expediting diagnostics and disposition decisions
• Initiate discharge planning and assess social determinants of health
• Maintain knowledge of CMS, Joint Commission, Medicare rules and related regulations
• Educate care team on continuum of care and safe patient transitions
• Identify risk management or quality issues and escalate appropriately
• Perform other duties as assigned by management

Skills

Communication skills

Negotiation

Conflict resolution

Data skills

Computer skills

Utilization review knowledge

Performance improvement

Education

BSN or related field

RN license (NJ)

Case management certification preferred

Enrollment in BSN program

Job description

Overview

CentraState Healthcare System, headquartered in Freehold, New Jersey, is a leading nonprofit healthcare provider dedicated to serving the community. Its comprehensive network includes CentraState Medical Center, a community-focused hospital, along with an ambulatory campus, two senior living facilities, three free-standing community health pavilions, and a charitable foundation. As the third-largest employer in Monmouth County, CentraState has earned repeated recognition as a Great Place to Work-Certified™ company, reinforcing its reputation as an exceptional workplace.

CentraState Medical Center has an employment opportunity available for an Emergency Department (ED) Nurse Care Manager . This position is responsible for establishing, coordinating, and maintaining processes that optimize patient throughput to the most appropriate level of care, while facilitating interdisciplinary care across the ED continuum. The Nurse Care Manager collaborates with patients and families, the multidisciplinary team, physicians, community resources, and payers to ensure appropriate determination of care level for both emergency and inpatient encounters, promoting efficient and cost-effective care delivery.

Responsibilities

• - Level of Care Determination: Completes initial medical necessity review on all ED patients with potential for admission, works with providers to identify appropriate level of care designation. Documents in accordance with established policy and procedure. Educates ED physicians and nurses about medical necessity and admission criteria.
• - Refers High Risk Patients to Social Services: Utilizes Social Work screening criteria to make appropriate social work referrals. Identifies patient/families with complex psychosocial, ongoing medical discharge planning issues, continuing care needs and refers to the social worker.
• - Implements Actions to Prevent Readmission: Collaborates with medical staff to recommend referrals for outpatient care, home health or other community agencies as indicated. Provides post-discharge follow-up by conducting or delegating the telephone evaluation of discharge plan. Works with time to establish interventions to manage high utilizers.
• - Supports Patient Flow: Intervenes to expedite the completion of diagnostic tests needed to determine disposition, offers alternatives to admission when appropriate, engages in boarder rounds to determine any needed changes in disposition.
• - Initiates discharge planning by conducting screenings for social determinants of health and initial discharge planning assessments for patients admitted through the emergency department.
• - Maintains knowledge of Federal, State, and other regulatory agency rules and regulations including The Joint Commission, CMS, Medicare, including but not limited to, knowledge of CMS rules regarding Observation status, the 2 Midnight Rule, and Medicare Inpatient Only Procedures.
• - Maintains knowledge of continuum of cares resources and provides education and resources relevant to the effective progression of care, utilization of services, appropriate level of care, and safe patient transition to the patient/family and health care team.
• - Identifies potential risk management and/or quality issues and works with the healthcare team to resolve such issues or refer them through the Chain of Command structure to the appropriate resource/committee.

Other duties as assigned by management.

Qualifications

• - BSN or Bachelor’s Degree in related field or current enrollment in BSN or related Bachelor’s Degree program required.
• - Prior clinical experience in care and management of hospitalized patients.
• - Experience in acute care utilization, preferred.
• - Utilization review or case management training from a professional Case Management organization, preferred.
• - RN license required/NJ.
• - Case Management certification preferred.
• - Excellent communication, negotiation, and conflict resolution skills
• - Data and computer skills
• - Knowledge of relevant and state utilization review and appeals requirements
• - Rapid cycle change or clinical performance improvement expertise

About Us

CentraState Healthcare System, in partnership with Atlantic Health System, is a fully accredited, not-for-profit, community-based health system dedicated to providing comprehensive health services in central New Jersey. Beyond offering a wide range of advanced diagnostic and treatment options, CentraState is committed to being a valuable health partner, focusing on disease prevention, promoting healthy behaviors, and helping individuals of all ages live well.

Located in Freehold, CentraState includes a 284-bed acute-care hospital, a dynamic health and wellness campus, two award-winning senior living communities, a charitable foundation, and convenient satellite health pavilions. These pavilions offer primary care, specialty physician practices, and access to outpatient services such as lab work and physical therapy.

CentraState is proud to be among the less than two percent of hospitals nationwide to earn Magnet® designation for nursing excellence five times. Additionally, it has been recognized as a Great Place to Work-Certified™ Company by Great Place to Work® for four consecutive years.

Joining CentraState means becoming part of a pioneering healthcare facility committed to high-quality, patient-focused care. We invite you to make a difference in our community and advance your career with us. We support our employees with work/life balance initiatives, tuition assistance, career advancement opportunities, and more.

Discover why our employees love their jobs and being part of the CentraState family!

CentraState Health System offers a competitive and comprehensive Total Rewards package that supports the health, financial security, and well-being of all team members.

What We Offer:

• - Medical, Dental, Vision, Prescription Coverage (30 hours per week or above for full-time and part-time team members)
• - Life & AD&D Insurance
• - Long-Term Disability (with options to supplement)
• - 403(b) Retirement Plan with employer match
• - 401(a) Retirement Plan with employer contribution
• - PTO
• - Tuition Reimbursement
• - Well-Being Rewards
• - Employee Assistance Program (EAP)
• - Fertility Coverage, Healthy Pregnancy Program
• - Flexible Spending & Commuter Accounts
• - Pet, Home & Auto, Identity Theft and Legal Insurance
• - Growth Opportunity and Workforce Development Initiatives
• - Continuing Education / Onsite Training
• - A warm, welcoming company culture based upon mutual respect and a collaborative goal of providing excellent patient care
• - Concierge Services with Work & Family Benefits
• - Magnet recognized healthcare facility

Compensation Range: $93,600 - $159,120 annually

The compensation above reflects the established range from CentraState Healthcare System (CSHS) for this position at the time the job was posted. CSHS considers many factors to determine compensation, including education, experience, skills, licenses, certification, and training. As such, team member compensation may fall outside this range.

Additionally, the compensation range reflects base salary and does not include extra shift rates or incentives tied to quality, productivity, etc., as applicable.

The benefits outlined also reflect CSHS’ policy at the time of posting. Benefits as are made available to other similarly situated team members of CSHS, although participation is at all times in accordance with and subject to the eligibility and other provisions of such plans and programs. CSHS may modify its benefits plans or programs at any time.

CSHS is proud to comply with all pay equity and pay transparency laws.