RN Case Manager, Emergency Department - 32h Days

Required Skills/Qualifications/Training/Experience:
•    Minimum 3-5 years acute care case management experience, with demonstrated skills in utilization review
•    Demonstrated ability to use critical thinking and problem solving skills in facilitating safe and timely patient transitions of care  
•    Excellent communication skills and positive interpersonal dynamic in working with a variety of stakeholders across the care continuum
•    Solid knowledge of all insurance plan regulations including CMS/Medicaid to ensure compliance with all required processes and documentation
•    Ability to garner and utilize information effectively to develop and modify patient plan of care
•    Strong analytical ability to interpret patient-related information, evaluate appropriateness of continued stay and/or need for ancillary services, and to reassess discharge planning needs based on daily assessment. 
•    Ability to successfully utilize industry accepted utilization and or medical management criteria in patient status decision making
•    Self-starter able to function independently within the scope of position and licensure, as well as department policies and established goals
•    Excellent computer skills to accurately document requisite information to support patient status and medical necessity

Preferred Skills/Qualifications/Training/Experience:
•    Experience in Cerner a plus
•    Denials management a plus

Educational Requirements:
•    BSN Graduate of an accredited school of nursing

License/Certification: 
•    RN with current Massachusetts license required
•    CCM (Certified Case Manager) Preferred
•    ACMA  (Accredited Case Manager) Preferred

Age Specific Criteria: Ability to effectively communicate to all age levels served within the scope of the position/assigned areas.
Ability to Meet Job Performance Expectations: Must have the ability to perform the essential functions of the position without posing a direct threat to the health and safety of themselves or other individuals in the workplace, with or without a reasonable accommodation.

            
Job Responsibilities:   
•    Use ED tracking system, medical record, and on-going communication with ED providers and team to identify potential admissions or alternative disposition as appropriate.  
•    Screen all ED patients for potential for admission to ascertain payer source and appropriate level of care designation.  
•    Collaborate with providers to determine, assign, and order appropriate level of care (LOC) designation and ensure medical record documentation. 
o    Determination of appropriate admission status (observation vs. inpatient) using standardized criteria; providing resources and education to the healthcare team.   
•    Initiate and/or complete initial review
•    Communicate LOC and/or length of stay (LOS) concerns to case management team for follow-up the next morning.
•    Consults with and takes referrals from ED providers, nurses, hospitalists, other care team members, ED patients, and families.  
o    Reviews all consults placed from ISAR screening tool and assists social worker with completion of these consults in order to provide patients with needed home referrals or rehab/SNF placement.
•    Responds to outside patient/family calls for follow-up care coordination questions. 
•    Uses ED tracking system, medical record, and demographic information to identify high-risk or any patient needing CM intervention. 
o    Identify patients with frequent ED visits utilizing the EHR and EDIE collective medical group notifications. 
o    Identify patient returning in 48 hours to ED or hospitalization within 30 days. 
•    Assess ED patients referred and/or identified through case finding for options other than acute hospital admission when appropriate:
o    Screen and refer to acute rehabilitation, long-term acute care hospitals, and nursing homes for admission directly from the ED.  
o    Screen and refer patients for whom treatments could be safely rendered at home with services (i.e., IV antibiotics, low molecular weight heparin injections, wound care, etc.)
o    Consult additional services to complete a safe and effective discharge plan, including physical therapy, social services, palliative care, interpreters, homeless advocates, patient financial services, behavioral health, etc. 
o    Communicate discharge planning information and/or concerns to team for follow-up the next morning. 
•    Initiate referral to long term care facilities, per patient/caregiver requests, following established referral procedures, initiates a PASRR screen, and ensures appropriate continuity of care information is provided to facility. 
•    Mandatory reporting to regulatory agencies
•    Provide additional community resources and support
 

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Sturdy Memorial Hospital is an equal employment opportunity employer. There is no discrimination because of race, color, creed, age, gender, sexual orientation, national origin, veteran status or disability.