Job DescriptionThe best thing about this roleAre you looking to make a difference by improving the health of our patients? Here you will find an innovative culture that is patient-focused and dedicated to making a difference. We are committed to helping the population we serve, and our communities, achieve optimum health and enjoy the best quality of life possible.What You'll DoThe Case Manager RN - ED acts a principle liaison between emergency services, surgical services, nursing, finance, physicians, utilization review and medical records to ensure appropriate bed is assigned, patient care needs are met, and treatment plans are executed in the appropriate level of continuum. The Case Manager RN - ED maintains current knowledge of basic healthcare economics, trends and reimbursements methodologies and applies knowledge to daily practices. The Case Manager RN - ED recognizes situations that require immediate intervention and continues to develop professionally and apply knowledge and skills necessary to provide care appropriate to each patient.
- Clinical and Technical Responsibilities:
- Provides case management services as appropriate throughout the life span and in various settings
- Evaluates discharge needs upon admission, ensuring each patient has a complete discharge plan; Refers discharge planning to appropriate roles as needed
- Proactively identifies and removes barriers that may impede department or system-wide patient flow
- Assigns available beds based on bed request priorities
- Communicates with patients and families about plan of care and discharge goals
- Provides the Hub with visibility to potential unit transfers in a timely manner
- ED Patients/New Admissions:
- Identify new ED patients
- Utilize ED tracking board
- Automated referral process
- Proactive rounding
- Review all admissions as soon as possible or within one hour of new admissions
- Review prior to admitting physician placing orders for admission
- Ensure on going communication between ED case manager (CM)/social worker (SW)and care team in the ED
- Complete and document initial discharge planning assessment fi time allows
- Obtain patients primary contact/decision maker for follow-up by inpatient (IP) CM/SW
- Refer patients with complex needs or high utilizers for SW Psychosocial Assessment
- Identify and document on any re-admission patients for follow-up by IP CM/SW
- Communicate any urgent needs to IP CM/SW
- Utilization Review:
- Complete admission review for medical necessity on observation (OBS) and inpatients (IP) using medical necessity criteria such as InterQual® (IQ) or Milliman Care Guidelines® (MCG)
- Collaborate with care team (ED physician, admitting physician, or other provider) on medical necessity criteria to address all discrepancies
- Complete initial clinical review in electronic medical record (EMR) and follow the required documentation standards for the initial review
- Pend any reviews that lack enough information to complete review
- Complete any review that meets criteria and schedule for next review
- Utilize knowledge of level of care (LOC) and hospital protocols to make recommendations for unit placement
- Review traditional Medicare fee for service (FFS) using the two-midnight rule
- Using documentation from the following to determine the start of care and need for two midnights: physician office, ambulance or ED
- Discuss alternative patient status/LOC as appropriate
- Responsibilities for Relationships:
- Collaboration and Teamwork: Collaborates with other health care team members providing patient- centered care
- Acts as a spoke of the Hub by partnering with other Care Coordinators to facilitate patient progression and flow at a unit level to achieve system efficiency
- Collaborates with the Hub to ensure appropriate patient placement and level of care (ICU, Med/Surg, etc.)
- Works collaboratively with unit staff and support team (Complex C3, etc.) to progress each patient's care towards discharge
- Rounds with physician to discuss patient progression and barriers to discharge
- Leads SNAP huddles to anticipate barriers to discharge and align care team towards discharge goals
- Serves as a consultant and educator with medical staff regarding status, placement, payor requirements, and utilization of resources
- Identifies patient for readmission risk and communicates to care team
- Coordinates the patient's plan of care in conjunction with physicians and Nurses for appropriate sequencing of care/interventions; ensures appropriate clinical pathways, protocols or standards of care are initiated
- Actively manages LOS for unit's patients through partnership and collaboration with all members of the healthcare team
- Financial Responsibilities:
- Responsibly apportions resources
- Reviews Physician admission order and validates status and level of care matches order
- Collaborates with UM Nurse to assure that all payor and status requirements are aligned according to patient's clinical progression
- Reviews LOS values and working DRG daily
- Proactively monitors patients in observation or outpatient status and progresses status accordingly
- Works with Nurse on discharge needs/barriers for all patients; initiates intervention by UM Nurse as needed
- Identifies need for patient to receive IM letter; collaborates with UM Nurse as needed
- Assists Clinical Documentation Specialist in engaging physician to respond to queries clarifying documentation to reflect appropriate severity of illness
- Identifies opportunities to transition testing to the outpatient setting
- Meets deadlines and exceeds metrics identified for the Facility/Unit through attention to detail and implementation of facility policies and Standard Operating Procedures
- Performs other duties as requested or assigned
EducationWhat we need from you
- 4 Year/Bachelor's Degree in Nursing, preferred
- 2 Year/Associate Degree in Nursing, required
- *** All RN's hired and do not currently hold a BSN will be expected to demonstrate enrollment in a bachelor's prepared nursing program within 4 years of hire. BSN must be completed within 10 years. RN's licensed on or before 12/19/17 are/remain exempt from this requirement
Experience
- Minimum 1 year acute care nursing experience, required
- Case management experience, preferred
Licensure/Certifications
- Current NYS Licensure as a Registered Nurse, required
- Case management certification, preferred
Skills
- Analysis & Evaluation
- Attention to Detail
- Build Relationships
- Clinical Skills
- Maintain Files
Physical Requirements
- Medium Work - Exerting up to 50 lbs. for force occasionally, and/or up to 20 lbs. of force frequently, and/or up to 10 lbs. of force constantly to move objects
- Occasional grasping, lifting, pulling, pushing, reaching, repetitive motion, standing, visual acuity (color, depth, perception), walking
- Frequent typing/clerical/dexterity, hearing, seeing/monitor/computer use, talking
- Constant fit testing
Hazards
- Occasional bodily fluids/bloodborne exposure
Working Conditions
Travel
Total RewardsBenefitsBassett Healthcare Network's commitment to our employees includes benefit programs carefully designed with the needs and values of all our employees in mind. Many of the benefits we offer are paid fully or in large part by Bassett. Our generous benefits offerings include:
- Paid time off, including company holidays, vacation, and sick time
- Medical, dental and vision insurance
- Life insurance and disability protection
- Retirement benefits including an employer match
- And more!
Specific benefit offerings may vary by location and/or position.Pay TransparencySalary is based on a variety of factors, including, but not limited to, qualifications, experience, education, licenses, specialty, training, and fair market evaluation based on industry standards. The above compensation range represents a good faith belief of the compensation range by Bassett Healthcare Network, and its entities and affiliates, at the time of this posting or advertisement.Pay Range MinimumUSD $95,058.82/Yr.Pay Range MaximumUSD $142,588.23/Yr.We love the difference people bringWe provide equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, sex (including pregnancy, childbirth, or related condition), age, national origin or ancestry, citizenship, disability, marital status, sexual orientation, gender identity or expression (including transgender status), genetic predisposition or carrier status, military or veteran status, familial status, status as a victim of domestic violence, or any other status protected by law.