ED Care Manager, FT Mercy Fitz Hospital

Trinity Health; Darby (Delaware County); On-site; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare system seeks an Emergency Department Care Manager to facilitate patient care coordination, ensuring appropriate levels of care and timely discharge planning. The role involves collaboration with interdisciplinary teams and addressing complex care needs while focusing on patient safety and quality improvements.

Qualifications

• Experience in care management and patient assessment.
• Knowledge of healthcare delivery systems and utilization criteria.

Responsibilities

• Facilitates patient entry into appropriate levels of care.
• Collaborates with healthcare teams to determine treatment plans.
• Coordinates discharge planning and referrals to community services.

Skills

Collaboration

Patient Safety

Clinical Care

Tools

InterQual

Milliman Care Guidelines

Job description

Employment Type:

Full time

Shift:

Evening Shift

Description:

Under the general supervision of the RN Care Coordination Manager and 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, utilizing appropriate medical necessity criteria including InterQual, Milliman Care Guidelines (MCG), and payor guidelines. The role involves reducing unnecessary hospital admissions, recommending correct levels of care (Outpatient Observation vs. Inpatient Admission), addressing issues related to readmissions, and ensuring safe discharges. The Care Manager facilitates timely throughput of emergency room patients to ensure safe healthcare delivery at the most appropriate level of care. Collaboration with Social Work is essential to identify community and other resources needed for each patient and to match specific care needs. The Care Manager also assists Social Work in obtaining authorization for services requiring pre-certification and ensures appropriate follow-up with primary care and specialist physicians. Additionally, they collaborate with the ED healthcare team to determine treatment plans, while monitoring quality, patient safety, length of stay, readmissions, and the risk of denials and appeals.

• Demonstrates understanding and incorporation of the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
• Screens all patients presenting to the ED for admission potential using appropriate utilization criteria (InterQual and MCG) to support physicians in determining the appropriateness of admissions and needed level of care.
• Recommends correct levels of care, paying attention to readmissions, non-contracted funders, and the risk of denials and appeals.
• Discusses cases that do not meet applied utilization criteria with the ED medical team, admitting team, and Physician Advisor as needed.
• Participates in obtaining notification and authorization for ED patients needing transfer to specialty units or other services.
• Assists the interdisciplinary team in formulating and implementing a comprehensive plan of care addressing physical, psychosocial, functional, financial, and health education needs.
• Assists in managing patients with frequent ED evaluations and refers patients to appropriate clinical settings.
• Assesses patients who do not require acute care to identify and evaluate complex care needs.
• Facilitates referrals to community services, including home health, long-term care facilities, palliative care, and hospice as needed.
• Coordinates ED discharge planning, providing patients with home health services, transportation, medical equipment, and education when appropriate.
• Maintains awareness of ED status and availability.
• Participates in data collection and analysis to support clinical care improvements.

Our Commitment to Diversity and Inclusion

Trinity Health, one of the nation's largest not-for-profit Catholic healthcare systems, is built on our Mission and Core Values. We prioritize diversity, equity, and inclusion in all aspects of our work. Our workforce's varied lived experiences, customs, abilities, and talents enable us to provide accessible and equitable care. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected status by law.