ED Care Manager

Major Responsibilities Identifies targeted patients within scope for ED CM interventions. Conducts focused assessments, establishes appropriate plans, and initiates interventions within desired timeframes. Collaborates and negotiates effectively with patient, family, and ED team while striving to achieve patient and organizational goals with regard to patient’s care needs, choice and satisfaction when determining potential alternatives to admission. Utilizes patient/family strengths in the problem-solving process, involving the patient/family and team in the decision-making process to effectively transition patients for admission or alternative support post-ED discharge. Provides continuity of care and discharge planning services compliant with regulatory standards by providing coordinated relevant options and services based on assessed needs to ensure patient/family and healthcare team is informed and able to proceed with accountabilities in a timely manner. This includes participating in the communication process to facilitate a smooth transition for patient, family, and staff when patients are transferred. Provides case management services related to various levels of health care, finances, housing, family discord, or illness adjustment, based on department scope. This may include managing family dynamics and crisis situations in a timely and professional manner, using community resources effectively, and educating patient/family regarding access to and use of services. Initiates internal and external referrals to secure services as an alternative to hospital admission. Documents discharge planning interventions and patient status screening activity per department and medical center standards in a timely manner. Performs and documents accurate and timely concurrent and retrospective reviews based on approved established criteria as required by department standards. Collaborates with managers, physicians, medical directors, advisory groups and treatment teams for issues related to physician practices and best practices to best understand standards of care for ED patient and hospital admissions. Refers cases to physician advisor as needed to ensure efficient site of care determination, accurate status, and compliance with regulatory guidelines. Remains knowledgeable in issues of healthcare regulations, reimbursement issues, impact on hospital admission, discharge planning, and community resources. Completes UM screening via established criteria to provide recommendations for appropriate status for patients who are unable to discharge from the ED. Develops and maintains productive relationships with community-based agencies and networks by representing Advocate Aurora Health Care in a positive manner working collaboratively, internally and externally, to meet patient/family needs. Works in collaboration with Advocate Aurora Ambulatory Care Management and Continuing Health to meet common goals and outcomes. Serves as an educator and expert resource to ED and hospital staff regarding admission status and acute care criteria, utilization management issues, care coordination and discharge planning needs, alternatives to admission and community resources, and relevant regulatory requirements. Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirements relative to his/her age‑specific needs, and to provide the care needed as described in the department’s policies and procedures. Age‑specific information is developed further in the departmental job standards. Major Responsibilities Identifies targeted patients within scope for ED CM interventions. Conducts focused assessments, establishes appropriate plans, and initiates interventions within desired timeframes. Collaborates and negotiates effectively with patient, family, and ED team while striving to achieve patient and organizational goals with regard to patient’s care needs, choice and satisfaction when determining potential alternatives to admission. Utilizes patient/family strengths in the problem-solving process, involving the patient/family and team in the decision‑making process to effectively transition patients for admission or alternative support post‑ED discharge. Provides continuity of care and discharge planning services compliant with regulatory standards by providing coordinated relevant options and services based on assessed needs to ensure patient/family and healthcare team is informed and able to proceed with accountabilities in a timely manner. This includes participating in the communication process to facilitate a smooth transition for patient, family, and staff when patients are transferred. Provides case management services related to various levels of health care, finances, housing, family discord, or illness adjustment, based on department scope. This may include managing family dynamics and crisis situations in a timely and professional manner, using community resources effectively, and educating patient/family regarding access to and use of services. Initiates internal and external referrals to secure services as an alternative to hospital admission. Documents discharge planning interventions and patient status screening activity per department and medical center standards in a timely manner. Performs and documents accurate and timely concurrent and retrospective reviews based on approved established criteria as required by department standards. Collaborates with managers, physicians, medical directors, advisory groups and treatment teams for issues related to physician practices and best practices to best understand standards of care for ED patient and hospital admissions. Refers cases to physician advisor as needed to ensure efficient site of care determination, accurate status, and compliance with regulatory guidelines. Remains knowledgeable in issues of healthcare regulations, reimbursement issues, impact on hospital admission, discharge planning, and community resources. Completes UM screening via established criteria to provide recommendations for appropriate status for patients who are unable to discharge from the ED. Develops and maintains productive relationships with community-based agencies and networks by representing Advocate Aurora Health Care in a positive manner working collaboratively, internally and externally, to meet patient/family needs. Works in collaboration with Advocate Aurora Ambulatory Care Management and Continuing Health to meet common goals and outcomes. Serves as an educator and expert resource to ED and hospital staff regarding admission status and acute care criteria, utilization management issues, care coordination and discharge planning needs, alternatives to admission and community resources, and relevant regulatory requirements. Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirements relative to his/her age‑specific needs, and to provide the care needed as described in the department’s policies and procedures. Age‑specific information is developed further in the departmental job standards. Minimum Education And Experience Required License/Registration/Certification Required: Registered Nurse License issued by the state in which the Team Member practices. Education Required: Bachelor’s degree in Nursing Experience Required: 2 years in clinical nursing Knowledge, Skills, And Abilities Required Ability to prioritize and organize work. Effective communication skills. Utilization of critical thinking and timely decision making. Ability to navigate the Electronic Health Record. Basic utilization of MS Office products. Knowledge of Medicare A and B guidelines. Knowledge of Managed Care program requirements/implications. Ability to apply elements of Utilization Management programs. Physical Requirements And Working Conditions Must be able to alternate between sitting and standing intermittently throughout the workday; stand and walk for the equivalent of several blocks at a time. Must lift up to 10 lbs. continuously, up to 20 lbs. frequently, and up to 50 lbs. occasionally. Manual dexterity required for operation computer and calculator. Visual acuity required for facilitating review of written documents/computer screens, medical records, and to record information accurately. Clear verbal communications and hearing acuity required for receiving instructions and converse on standard telephone. Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone. Exposed to normal office environment; including usual hazards related to operating electrical equipment. Operates all equipment necessary to perform the job. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. #J-18808-Ljbffr Advocate Health Care