ED Care Manager, FT Mercy Fitz Hospital

Trinity Health; Philadelphia (Philadelphia County); On-site; USD 60,000 - 100,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated Emergency Department Care Manager to enhance patient care and streamline processes. This role is pivotal in ensuring patients receive the right level of care, reducing unnecessary admissions, and facilitating safe discharges. Collaborating with a multidisciplinary team, you'll utilize your expertise in care coordination and community resources to support patients' diverse needs. If you're passionate about making a difference in healthcare and thrive in a dynamic environment, this opportunity is perfect for you.

Qualifications

• Experience in care coordination and utilization management.
• Knowledge of medical necessity criteria and community resources.

Responsibilities

• Assist in facilitating patient entry into appropriate care levels.
• Coordinate discharge planning and follow-up care.

Skills

Care Coordination

Utilization Management

Patient Advocacy

Community Resource Coordination

Education

Bachelor's Degree in Nursing

Registered Nurse License

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 medical necessity criteria such as InterQual, Milliman Care Guidelines (MCG), and payor guidelines. The role involves reducing unnecessary hospital admissions, recommending appropriate levels of care (Outpatient Observation vs. Inpatient Admission), and addressing issues related to readmissions and safe discharges. The Care Manager ensures timely throughput of emergency room patients, collaborates with Social Work to identify community resources, and assists in obtaining authorization for services requiring precertification. Additionally, the role includes coordinating follow-up care and treatment plans with the ED healthcare team, ensuring quality and patient safety, managing frequent ED evaluations, and facilitating referrals to community services.

• Demonstrates understanding and incorporation of Trinity Health Mission, Vision, and Values in daily practices.
• Screens all ED patients for admission potential using utilization criteria to support physician decisions.
• Recommends appropriate levels of care, considering readmissions, funder requirements, and risk of denials.
• Discusses cases that do not meet utilization criteria with the medical team and Physician Advisor as needed.
• Participates in obtaining notifications and authorizations for transfers and services.
• Assists in formulating and implementing comprehensive care plans addressing physical, psychosocial, functional, financial, and educational needs.
• Manages patients with frequent ED visits and refers to suitable clinical settings.
• Evaluates patients who do not require acute care to identify complex needs.
• Facilitates referrals for community services, including home health, long-term care, palliative care, and hospice.
• Coordinates discharge planning, including home health services, transportation, and education.
• Maintains awareness of ED status and capacity.
• Participates in data collection and analysis to support clinical care improvements.

Our Commitment to Diversity and Inclusion

Trinity Health, one of the largest not-for-profit, Catholic healthcare systems in the nation, is committed to diversity, equity, and inclusion. Our workforce reflects diverse lived experiences, talents, and backgrounds, enabling us to provide accessible and equitable care. Trinity Health is an Equal Opportunity Employer, considering all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected status.