Emergency Department Care Manager - Case Management

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Uses approved criteria to conduct patient assessment and admission clinical review to ensure the appropriateness of setting and timely implementation of the plan of care.
• Performs review of anticipated admissions, placements in Observation status, and discharges using evidence-based criteria set for appropriate level of care assignment.
• Provides identification of patients for whom standard of care treatments could be safely rendered at home.
• Screens appropriateness of admission including observation versus inpatient status.
• Educates ED physicians and nurses about medical necessity and admission criteria.
• Collaborates with physicians and other members of the treatment team on documentation needs and opportunities.
• Utilizes high-risk screening criteria to make appropriate community and post-ED referrals.
• Initiates prior authorization process when indicated for post-ED referrals and services.
• Escalates to physician advisor when unable to resolve discrepancies with the attending physician.
• Manages high-use patients and works to find alternatives for care to frequent ED visits.
• Plans for discharges from the ED for patients who do not require admission to include arranging for Home Health, DME, placement, and community resources as they relate to social determinants of health.
• Provides patient and family education and counseling about existing health problem-related care.
• Anticipates barriers/variances to the delivery of care and intervenes as necessary.
• Intervenes with physicians and ancillary departments concerning clinical and utilization issues to ensure optimal patient outcomes.
• Coordinates and facilitates patient progression throughout the continuum.
• Collaborates with all members of the interdisciplinary team to facilitate appropriate care coordination and care delivery.
• Able to analyze clinical information and accurately apply clinical criteria.

• Graduate of an accredited school of nursing (BSN preferred) or Master?s degree in Social Work (MSW) required

• 3+ years of relevant clinical case/care management experience in the acute care setting required
• Familiarity with evidence-based medical necessity criteria sets required
• Competency in prior authorization functions and software, including the application of criteria and timelines required
• Proficiency in medical and managed care terminology required

• RN or LMSW in the state of employment is required
• Case Manager certification preferred
• BLS preferred

CHRISTUS Health is an international faith-based, not-for-profit health care system based in Irving, Texas, with more than 60 hospitals in Texas, Louisiana, New Mexico, Chile, Colombia and Mexico. CHRISTUS Health is made up of 50,000 Associates providing compassionate and individualized care at more than 600 centers, including community hospitals, clinics, long-term care facilities and health ministries. Sponsored by the Sisters of Charity of the Incarnate Word of Houston, Sisters of Charity of the Incarnate Word of San Antonio and the Sisters of the Holy Family of Nazareth, our mission is to extend the healing ministry of Jesus Christ to every individual we serve.