Trinity Health 2000-T1005 RN Emergency Department Case Manager in Philadelphia, Pennsylvania
Under the general supervision of the Director of Care Coordination, the Emergency Department Care Manager assists physicians and the interdisciplinary team in facilitating the entry of patients into the appropriate level of care by utilizing InterQual criteria. Reduces unnecessary admissions to the acute care hospital. Has accountability for assigning correct levels of care (Outpatient Observation vs. Inpatient Admission), attention to the issues presented by readmissions and recommending options for safe discharge. Coordinates all non-elective point of entry admissions (including direct admissions and SPU) and facilitates timely throughput of emergency room patients to ensure the safe delivery of services to the patient at the most appropriate level of care. Responsible for identifying community and other resources that are necessary for each individual patient and matches specific needs for continued care that are acceptable to the patient. Identifies services that require authorization and collaborates with payers to obtain needed authorizations for services. Ensures patient has a primary care physician follow-up. Collaborates with the ED healthcare team to determine the treatment plan, while observing quality and patient safety parameters, LOS, readmissions, denials and appeals.
Education and Training
BSN or BA in Nursing. Enrolled or committed to enroll in a BSN or BA in Nursing program, making steady progress towards degree.
Certification and Licensure Registered Nurse licensed in the State of Pennsylvania Case Management certification from an accredited organization preferred.
Managed care, government payers, third-party reimbursement
InterQual criteria and its application
Information systems, Midas preferred
Using MS Office applications
Developing and maintaining strong interpersonal relationships
Oral and written communication skills
Ability to document in an electronic health record completely and accurately
Experience Three (3) years of utilization management or case management experience, including emphasis on discharge planning.
Job Number: 00196147
Location: Philadelphia, PA
Organization Name: Mercy Health System of Southeastern Pennsylvania
Facility: MSEPA - Nazareth Hospital
Employment Type: Full time