Emergency Room RN Case Manager

Job Description

Job Description

Schedule: 8am to 4:30pm with one weekend every four weeks

Shift Differential: $2.50/hr evenings, $2.00/hr weekends

Role Summary:

• Performs a comprehensive assessment of psychosocial and medical needs of assigned patients 
• Develops a case management plan of care to include identified clinical, psychosocial and discharge needs; coordinates plan of care; plan is documented in the medical record; plan is communicated to appropriate clinical disciplines 
• Assumes a leadership role with the interdisciplinary team to manage care, through criteria driven processes, for the appropriate level of care, patient status and resource utilization 
• Conducts interdisciplinary team meetings to provide a mechanism for all clinical disciplines to collaborate, plan, implement, and assess the plan of car; patient selection should be criteria based and interventions will be documented 
• Evaluates admissions for medical necessity using approved criteria at defined intervals throughout the episode of care; escalates medical necessity and admission status issues through the established chain of command 
• Evaluates and assess observation patients for appropriateness in observation status 
• Performs utilization management reviews and communicates information to third party payors 
• Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies 
• Demonstrates knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives as it relates to the provision of Case Management Services 
• Makes appropriate referrals to third party payer disease and case management programs for recurring patients and patients with chronic disease states
• Documents professional recommendations, care coordination interventions, and case management activities to effectively communicate to all members of the health care team 
• Facilitates patient throughput with an ongoing focus on quality and efficiency 
• Tracks and trends barriers to care; makes recommendations and develops action plans to improve processes and systems 
• Involves patient, family/responsible/significant others in identifying and clarifying needs and expectations to develop mutual and realistic goals 
• Assesses patients’ post discharge needs and facilitates the provision of services necessary to meet identified needs 
• Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered 
• Identifies patients with the potential for high risk complications and makes appropriate referrals acting as an advocate for the individual’s healthcare needs 
• Directs activities to identify and provide for the needs of the under resourced patient population to include patient education activities, patient assistance programs, and community based resources 
• Develops individual plans of care for recurring patients to include education on appropriately accessing healthcare resources, preventative education, and community based resources 
• Assumes a leadership role in the development, revision, and implementation of clinical protocols which transition patients across the continuum of care or discharge patients to an appropriate service level of care 
• Tracks and trends variances to care and barriers to care; makes recommendations and develops action plans to improve processes and systems 
• Adheres to established policy and procedure and standards of care; escalates issues through the established Chain of Command timely 
• Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered. 
• Demonstrates knowledge of the occurrence reporting system. Uses system to report potential patient safety issues. 
• Follows established guidelines for reporting a significant medical error or unanticipated outcome in the patient’s care which results in patient harm. 
• Attends in-service presentations and completes all mandatory education requirements. 
• Uses Performance Improvement Plan to improve patient safety. 
• Regular, Punctual and dependable attendance. 
• Other duties as assigned

Qualifications:

• Candidates are required to have a minimum of 3 years of RECENT (Within the last year) Case Manager experience in an acute care setting. The HM is also open to candidates with 3 years of experience on the following units: Med/Surg, Tele, Neuro, ICU, PCU, or ED. *will also consider candidates with Case manager experience in home health or insurance. For home health and insurance, they must have 3 years of acute care experience total and must have at least 1 year of acute care experience within the last 5 years.
• Associates Degree in Nursing or Diploma in Nursing required 
• Bachelor’s Degree in Nursing preferred 
• Current FL RN license required or appropriate compact licensure. If compact license held, active FL RN licenserequiredwithin90 days of hire 
• Advanced Practice Registered Nurse license is acceptable for position if current and compliant
• Certification in Case Management, Nursing, or Utilization Review, preferred