Registered Nurse RN - ED Admission Case Manager

Job Category

Nursing
- Registered Nurse

8 Hr Afternoon
- Evening

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

Job Summary

The ED Admissions Case Manager evaluates and screens all ED admissions using screening guidelines to ensure patients are in the appropriate status and level of care based on the physician's documentation. The ED Admissions Case Manager collaborates with physicians, patients and families, and other members of the healthcare team to ensure an appropriate plan of care and the appropriateness of services provided.

The ED Admissions Case Manager provides comprehensive assessment, planning, implementation, and overall evaluation of individual patient needs. Additionally, the ED Admissions Case Manager coordinates a team approach to facilitate achievement of expected patient outcomes with appropriate transitions to the next level of care and also provides cross-coverage for other ED RN Case Managers as required.

• Licensure or other certifications: Professional RN licensure, Active GA licensure

• Educational Requirements: Associate degree. Graduate of an accredited school of nursing.

• Minimum Experience: One to two years of experience in Utilization Management applying screening guidelines (Inter Qual or MCG Guidelines) or other related Case Management experience (e.g., Acute Care, Insurance Case Management, Workers Compensation). Three to five years of experience in direct patient care and/or case management.

• Other: N/A

• Preferred Licensure or other certifications: Case Management Certification (CCM or ACM) preferred.

• Preferred Educational Requirements: Bachelor's Degree

• Preferred Experience: Acute Care UR/CM experience preferred.

• Other: N/A

• Demonstrated aptitude, clinical knowledge, and critical thinking skills in a fast-paced ED environment.

• Working knowledge of State and Federal regulations, third-party/governmental payer regulatory requirements, and in- and out-of-network coverage benefits.

• Excellent observation, analytical thinking, problem-solving, and written and verbal communication skills.

• Proficiency with computers and software.

• Knowledge of financial/reimbursement criteria as it relates to all payors.

• Strong interpersonal skills, professionalism, teamwork, and the ability to be self-directed.

• Determine if patients meet nationally recognized medical necessity criteria for admission/transfer by using screening guidelines (Inter Qual/MCG) based on physician documentation to ensure proper patient class and level of care.

• Coordinate patient entry into NGMC's acute beds, assess medical appropriateness and patient status, and communicate with physicians and referring facilities to ensure collaborative practice.

• Refer appropriate cases to physician advisors for review and determine status orders based on findings.

• Work collaboratively with physicians, nursing staff, and the care team to ensure patients meet expected length of stay and achieve timely discharge and appropriate transitions to the next level of care.

• Communicate and coordinate with the care team to maintain correct status and level of care; support a customer-service oriented environment to enhance satisfaction.

• Adhere to regulatory and DNV requirements; be knowledgeable of third-party payers to facilitate appropriate outcomes and coverage of services rendered.

• Provide physician education and feedback, including guidance for status determinations and supporting documentation for medical necessity.

• Maintain confidentiality and respect patient privacy in accordance with HIPAA laws.

• Support productive operation of the Care Coordination area and identify opportunities for process improvement.

Emergency Department and Observation Unit (COU, EOU, MOU)

• Provide coordination and oversight of patient care to ensure required interventions occur in proper sequence and timelines; identify and address potential delays and escalate unresolved delays to management for appropriate intervention.

• Assess, coordinate, and facilitate discharge planning to arrange post-acute needs; communicate plan with physician, patient/family, and care team; reassess discharge plan routinely to ensure timely, safe discharge and appropriate transition to the next level of care. Provide patient/family with information about plan of care, discharge, and any financial responsibilities.

• Weight Lifted: Up to 20 lbs, occasionally 0-30% of time

• Weight Carried: Up to 20 lbs, occasionally 0-30% of time

• Vision: Moderate, frequently 31-65% of time

• Kneeling/Stooping/Bending: Occasionally 0-30%

• Standing/Walking: Occasionally 0-30%

• Pushing/Pulling: Occasionally 0-30%

• Intensity of Work: Occasionally 0-30%

• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

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