Emergency Department Care Manager, ED Care Management - PRN

Case Management Society of America (CMSA) ®; Beaumont (TX); On-site; USD 80,000 - 110,000; Part time

Job summary

A prominent healthcare organization seeks an Emergency Department Care Manager in Beaumont, Texas, to enhance patient care coordination and management. The role involves collaborating with multidisciplinary teams to ensure appropriate patient care levels and providing education to staff. Ideal candidates should possess strong clinical case management experience and the necessary nursing or social work qualifications, as well as familiarity with medical necessity standards. This is a per diem position with flexible scheduling based on need.

Qualifications

• 3+ years of clinical case/care management experience in acute care required.
• Familiarity with medical necessity criteria sets needed.
• Must possess RN or LMSW license in Texas.

Responsibilities

• Coordinate patient throughput and level of care decisions.
• Educate staff on medical necessity and admission criteria.
• Manage discharges and referrals for additional care.

Skills

Patient assessment

Care management

Resource management

Clinical criteria application

Education

Graduate of an accredited school of nursing (BSN preferred)

Master’s degree in Social Work (MSW)

Tools

Prior authorization software

Job description

Description

Summary:

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.

Job Requirements:

Education/Skills

• 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:

TBD

Work Type:

Per Diem As Needed