ED Case Manager 0.75 FTE

Sutter Health Castro Valley , CA 94546

Posted 2 months ago

POSITION SUMMARY:

The Emergency Department (ED) RN Case Manager initiates admission screening in the ED to support that the right care is provided at the right place and at the right time. Using InterQual criteria to evaluate the appropriateness of admission, level of care, and readiness for disposition from the ED, the ED CM facilitates movement of patients through the ED; conducts timely screening reviews, collaborates with the ED physician and nursing staff to identify patient's admission status or potential case management needs, proactively assesses post-care needs, coordinates care with the treatment team, family and others as necessary. Actively works to prevent unnecessary (re)admissions by coordinating and finding resources. The ED Case Manager reports to Manager or Supervisor of Care Coordination. The ED Case Manager has frequent contact with patients, families, nurses, physicians, payers and review agencies, contracted providers and community resources.

MINIMUM POSITION REQUIREMENTS:

Education:

  • BS in one of following: Nursing or Health related field. Masters in nursing, case management or other health related field preferred.

  • National Certification in Case Management (i.e. ACM, ANA RN-BC Case Management) preferred.

  • Current California RN licensure required.

Experience:

  • Minimum of three (3) years in acute medical/surgical/ED/ or critical care nursing area required. Masters of Nursing in Case Management in lieu of three (3) years in acute medical/surgical/ED/ or critical care nursing area may be considered for employment at director's discretion.

  • Previous ED Case Management experience preferred.

  • Experience utilizing electronic InterQual or other standardized criteria strongly preferred.

  • Experience with clinical assessment for patient with complex medical, emotional and social needs.

  • Experience using an electronic medical record system

  • Experience and knowledge with MIDAS preferred

Knowledge:

  • Excellent interpersonal communication and negotiation skills.

  • A broad knowledge base of health care delivery and case management within a managed care environment.

  • Comprehensive knowledge of Utilization Review, levels of care, and observation status

  • Some awareness of healthcare reimbursement systems: HMO, PPO, PPS,CMS preferred

  • Post-acute levels of care such as Home Health, Hospice, AIM, and Palliative Care. SNF, LTAC, B&C, Sub-acute, Acute rehab

  • General Knowledge of DRG assignment process preferred.

Skills:

  • Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners.

  • Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.

  • Demonstrates commitment to service excellence in all patient, family and employee interactions and in performing all job responsibilities.

  • Functions in a manner to promote quality patient care and assure a positive patient experience.

  • Excellent verbal and written communication skills.

  • Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.

  • Intermediate computer skills.

  • Ability to promote teamwork and to effectively function in teams.

  • Ability to interact effectively with key internal and external constituents using collaboration, and customer service skills that promote excellence in the patient experience.

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ED Case Manager 0.75 FTE

Sutter Health