ED RN Case Manager - UR & Discharge Planning

Job Type: Regular

Time Type: Part time

Work Shift: Day (United States of America)

FLSA Status: Non-Exempt

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.

30hpw; day shift with flex start times; 7:30a- 6:00p or 8:00a - 6:30p. Every third weekend. One summer and one winter holiday.

Job Description:

The Emergency Department Case Manager is responsible and accountable for patient trajectory by assisting the healthcare team in improved patient outcomes. The focus is to identify the most appropriate level of care while facilitating throughput. The ED Case Manager will assist in identifying patients appropriate for Admission, Observation, or other patient care status.

This role is structured around four major functions

• Utilization Management

• Care Coordination

• Discharge Planning

• Preventing Unnecessary Re-admissions

Each of these functions support the Care Transitions Department's goals of 1) Improving patient satisfaction and patient outcomes, 2) Decreasing length of stay, 3) Decreasing unit cost, 4) reducing readmissions.

Duties/Responsibilities:

A. Utilization Management

Performs review of anticipated admissions utilizing InterQual criteria to assess for appropriate level of care assignment. Certifies Medicare admissions and utilizes Code 44 when appropriate Serves as a resource to patients, physicians, administration and hospital employees regarding issues related to patient classification and reimbursement. Refers inappropriate observation or anticipated admission cases to the Physician Advisor. Provides real time interventions to prevent delays and ensure compliance and revenue integrity with health care regulations Functions as a liaison between physicians and Physician Advisors Identifies and collects data regarding resource utilization for physicians, management and administration for evaluation and process improvement.

B. Discharge Planning

Creates and coordinates the overall transition plan of care based on initial assessment and concurrent collaboration with other care givers, external service organizations, agencies and healthcare facilities, community care and navigation services, and the patient and family/caregiver. Facilitates smooth care transitions by ensuring appropriate clinical follow-up is arranged and referrals to proper post-acute providers are initiated. Increases patient and family satisfaction with the discharge from the ED Prevents unnecessary admissions for social reasons Functions as a liaison between the DEM and community-based resources on an as-needed basis Provides assessment, information, referrals, and other resource assistance to patient/family as needed Facilitates treatment, admission, discharge, and/or