Emergency Department Care Manager - Case Management

CHRISTUS Health; Santa Fe (NM); On-site; USD 70,000 - 95,000; Full time

Job summary

CHRISTUS Health in Santa Fe, NM seeks an Emergency Department Care Manager to optimize patient throughput and coordinate care across the continuum. The role requires strong clinical judgment and collaboration with nurses, physicians, care managers, and community partners to determine the appropriate level of care.

You will assess patients, facilitate discharge planning, manage high-use cases, and arrange home health, DME, and post‑ED referrals while addressing social determinants of health.

Qualifications

• Must have BSN or MSW degree.
• RN or LMSW license in the state of employment.
• Familiar with evidence-based medical necessity criteria and prior authorization processes.

Responsibilities

• Assess patient status and determine appropriate level of care.
• Coordinate discharge planning with Home Health, DME, and community resources.
• Educate patients and families about care plans and options.
• Collaborate with physicians and care team to optimize patient outcomes.
• Manage high-use patients and complex discharge planning.

Skills

Clinical case management

Interdisciplinary collaboration

Healthcare terminology

Education

BSN or MSW degree

Tools

Prior authorization software

Job description

Description

The Emergency Department (ED) Care Manager is responsible for establishing, coordinating, and maintaining the process to increase patient throughput to the most appropriate level of care while facilitating interdisciplinary care across the continuum for the ED. The Care Manager collaborates with the patient and/or family, multidisciplinary team, physicians, community partners, and payers to ensure the patient’s progress and level of care are appropriately determined. The Care Manager has well-developed knowledge and skill in patient status in the inpatient and outpatient settings and collaborates with other care managers, social workers, Patient Access, physicians, and administrative leadership in the ED to determine the appropriate level of care. The Care Manager also has a robust understanding of services and resources outside of the hospital that would be of benefit to the patient and initiates referrals as indicated. This work includes patient assessment and management, resource management, identifying patients appropriate for admission, observation or outpatient status, care facilitation, discharge planning with referrals to all levels of care, and other duties related to the defined population.

Responsibilities

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Uses approved criteria to conduct patient assessment and admission clinical review to ensure the appropriateness of setting and timely implementation of the plan of care.
• Performs review of anticipated admissions, placements in Observation status, and discharges using evidence-based criteria set for appropriate level of care assignment.
• Provides identification of patients for whom standard of care treatments could be safely rendered at home.
• Screens appropriateness of admission including observation versus inpatient status.
• Educates ED physicians and nurses about medical necessity and admission criteria.
• Collaborates with physicians and other members of the treatment team on documentation needs and opportunities.
• Utilizes high-risk screening criteria to make appropriate community and post-ED referrals.
• Initiates prior authorization process when indicated for post-ED referrals and services.
• Escalates to physician advisor when unable to resolve discrepancies with the attending physician.
• Manages high-use patients and works to find alternatives for care to frequent ED visits.
• Plans for discharges from the ED for patients who do not require admission to include arranging for Home Health, DME, placement, and community resources as they relate to social determinants of health.
• Provides patient and family education and counseling about existing health problem-related care.
• Anticipates barriers/variances to the delivery of care and intervenes as necessary.
• Intervenes with physicians and ancillary departments concerning clinical and utilization issues to ensure optimal patient outcomes.
• Coordinates and facilitates patient progression throughout the continuum.
• Collaborates with all members of the interdisciplinary team to facilitate appropriate care coordination and care delivery.
• Able to analyze clinical information and accurately apply clinical criteria.

Education/Skills

Job Requirements:

• Graduate of an accredited school of nursing (BSN preferred) or Master’s degree in Social Work (MSW) required

Experience

• 3+ years of relevant clinical case/care management experience in the acute care setting required
• Familiarity with evidence-based medical necessity criteria sets required
• Competency in prior authorization functions and software, including the application of criteria and timelines required
• Proficiency in medical and managed care terminology required

Licenses, Registrations, or Certifications

• RN or LMSW in the state of employment is required
• Case Manager certification preferred
• BLS preferred

Work Schedule

5 Days - 8 Hours

Work Type

Full Time