Case Manager - Emergency Department
The Emergency Department Case Manager performs initial patient assessments for utilization review, care coordination, and discharge planning purposes in the Emergency Department. The ED Case Manager combines their professional knowledge base and experience with critical thinking skills to support the delivery of effective and efficient ED patient care. The ED Case Manager works collaboratively with physicians and other members of the interdisciplinary healthcare team in the ED in determining the most appropriate level of care for continuation of treatment: inpatient admisson, observation admission, or discharge.
Provides patient care, treatment, and services within the scope of their license, certification, registration, and/or assessed competencies. Practice will be in accordance with laws and regulations and will adhere to established policies, procedures and practice guidelines.
- Assesses potential admissions for appropriate level of care and setting, using InterQual and/or CMS criteria for determining observation versus inpatient status.
- Communicates the InterQaul findings to physicians, helping to determine the proper patient designation and assists physicians in determning a specific plan of care.
- Maintains accountability for facilitating clinical patient progression through the ED and integrates the nursing process (assess, plan, implement and evaluate) and a quality management process (plan, do, check, act) as the framework for decision-making and problem solving.
- Assesses patients in the ED for clinical and discharge needs, facilitates hospital admissions, and assists with transfers to other facilities or discharges to alternative settings as appropriate
- Documents appropriately in the medical record, completing the initial utilization review when possible and communicates with floor Case Management about patient information to provide efficient coordiantion of care.
- Applies clinical expertise to faciliate utilization review,ensure appropriate resource utilization, and notification/approval by payers.
- Works with collaboratively with members of an interdisciplinary ED team in improving quality, service, and financial aspects of overall patient care management.
- Participates in continuous quality improvement teams and activities.
- Participates in supporting the organization’s vision, mission and values and adheres to DeKalb Medical Standards of Behavior.
- Performs other duties as assigned to meet the goals and objectives of DeKalb Medical.
Minimum Education, Experience and Licensure Required:
· Graduate of an accredited school of Nursing
· Bachelor’s degree in Nursing (BSN) preferred
· Current Georgia Licensure as a Registered Nurse
· Minimum of two (2) years recent acute care experience required, with emergency department clinical experience preferred
· Utilizaton Review and/or discharge planning experience strongly preferred
· Case Management Certification preferred
Skills, Knowledge and Abilities:
· High degree of self motivation and directional initiative.
· Excellent customer service skills and strong drive to provide compassionate care.
· Critical thinking skills, decisive judgment and the ability to work with minimal supervision in a fast paced environment.
· Strong communication skills with ability to effectively communicate technical information to patients and families.
· Ability to effectively manage multiple tasks and priorities within a fast-paced environment.
· Ability to collaborate effectively with multidisciplinary healthcare teams.
- Must be able to perform skills and competencies as defined in orientation checklist and annual departmental competency checklist if applicable.
- Demonstrates and maintains competencies specific to patient population served.