Case Manager RN Emergency Department in Gardena, CA at Avanti Hospitals

Date Posted: 5/15/2018

Job Snapshot

Job Description

Memorial Hospital of Gardena

Job Title: Case Manager RN Emergency Department 

City: Gardena / State: California    

Case Management

Day Shift

From 10:30 AM

To 11:00 PM

                                      


Job Description and Job Responsibilites

Job Title:        Case Manager – RN – Emergency Department (ED)

Reports to:      Director, Case Management 

Job Summary: 

  • Coordinates and facilitates the care of ED patients.
  • Works with the ED Physician and ED health care team to evaluate the appropriateness of admission and level of care based on InterQual criteria and readiness for discharge.
  • Works with the payor to determine whether a patient should be hospitalized as a full admission or as observation status. If a patient is stable and is approved for transfer to another facility, assures timely movement of patient through the continuum of care by conducting concurrent reviews and resolving delays as necessary.
  • Assists the ED physician and ED healthcare team in efficiently moving the patient through the ED continuum of care. Ensures documentation is accurate and complete and it matches the patient’s clinical condition.
  • Documents case management activities in the patient record and in the required information system, i.e. in Paragon UR (Utilization Review) Program, CERME, Nursing Progress Notes.
  • Works varying shifts including regular evenings and weekends.

 

Essential Job Duties:  

  • Collaborates with the ED physician to determine the appropriate level of care by patient rounding with the physician using InterQual criteria and appropriate reimbursable diagnoses.
  • Ensure prior authorization is obtained from payor/delegated IPA for patient admissions.
  • Assess the needs of high-risk ED discharge patients, developing appropriate and safe discharge plans and determining the need for alternative settings. Attends rounds with the Physician Advisor, Nursing and other members of the Case Management team to discuss the gaps in patient care; responds to the patients’ needs.
  • Communicates with payors, community physicians, family or caretaker and agencies for transfer or discharge placement. Educates clinical staff about admission criteria, necessity of admission, and alternative placement settings.
  • Monitors and manages variances and elements that are a misuse of resources or issues that may extend length of stay.
  • Must be self-directed and organized with the ability to independently prioritize and follow through to achieve desired clinical, satisfaction and financial outcomes.
  • Prevents denials and disputes by communicating with payers and documenting relevant information in Paragon UR.
  • Reviews in-house patients as assigned by the CM Director.

 

Behavioral Standards:   

  • Exhibits customer and service oriented behaviors in every day work interactions.
  • Demonstrates a courteous and respectful attitude to internal workforce and external.
  • Develops an organized work plan in a high-volume environment with rapidly changing priorities.
  • Effectively communicates with, and promotes cooperation and collaboration among patients/families, physicians, nurses, community resources and social workers.
  • Utilizes critical thinking skills and clinical knowledge to create a viable and effective patient transition plan while identifying delays in service or quality issues impeding progression of care.
  • Serves as a role model for Avanti’s Mission, Vision and Values; fulfills other job duties as requested.

 

Collaboration/Teamwork:

  • Contributes toward effective, positive working relationships with internal and external colleagues.
  • Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities and a willingness to collaborate with others for the good of the customer and the organization.
  • May assist in other units if business needs are required.

 




Job Requirements

Education/Experience:

  • Bachelor’s degree in Nursing preferred.
  • Minimum of 2 years as a Case Manager in an Acute Care setting, preferably in the ICU or Emergency Department.
  • Knowledge of healthcare reimbursement systems: HMO, PPO, capitated agreements, and PPS.
  • Advanced knowledge of post- acute healthcare resources such as SNF, Home Health and Hospice.
  • Must have strong clinical assessment skills necessary to provide utilization review and transition planning services to meet the patients’ complex medical, emotional and social needs.

 

Licensure/Certifications:

  • Current RN licensed in good standing by the California Board of Nursing
  • Current BLS for Health Care Provider card under the auspices of the American Heart Association.
  • Accredited Case Manager (ACM) or Certified Case Manager (CCM) a plus.

 

ADA/Physical Demands:

  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant to be considered.
  • Required to stand; walk; sit; use hands to fingers, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl; talk and hear; and may taste and smell. The employee is regularly required to lift, push and/or pull weights over 10 pounds, with assistance. Visual abilities, auditory abilities, must be intact to perform duties.

 

 

Job Requirements

Education/Experience:

  • Bachelor’s degree in Nursing preferred.
  • Minimum of 2 years as a Case Manager in an Acute Care setting, preferably in the ICU or Emergency Department.
  • Knowledge of healthcare reimbursement systems: HMO, PPO, capitated agreements, and PPS.
  • Advanced knowledge of post- acute healthcare resources such as SNF, Home Health and Hospice.
  • Must have strong clinical assessment skills necessary to provide utilization review and transition planning services to meet the patients’ complex medical, emotional and social needs.

 

Licensure/Certifications:

  • Current RN licensed in good standing by the California Board of Nursing
  • Current BLS for Health Care Provider card under the auspices of the American Heart Association.
  • Accredited Case Manager (ACM) or Certified Case Manager (CCM) a plus.

 

ADA/Physical Demands:

  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant to be considered.
  • Required to stand; walk; sit; use hands to fingers, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl; talk and hear; and may taste and smell. The employee is regularly required to lift, push and/or pull weights over 10 pounds, with assistance. Visual abilities, auditory abilities, must be intact to perform duties.

 

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