OverviewCentraState Medical Center has an employment opportunity available for an Emergency Department (ED) Nurse Care Manager. This position is responsible for establishing, coordinating, and maintaining processes that optimize patient throughput to the most appropriate level of care, while facilitating interdisciplinary care across the ED continuum. The Nurse Care Manager collaborates with patients and families, the multidisciplinary team, physicians, community resources, and payers to ensure appropriate determination of care level for both emergency and inpatient encounters, promoting efficient and cost-effective care delivery.
Responsibilities
Responsibilities include, but are not limited to:
- Level of Care Determination: Completes initial medical necessity review on all ED patients with potential for admission, works with providers to identify appropriate level of care designation. Documents in accordance with established policy and procedure. Educates ED physicians and nurses about medical necessity and admission criteria.
- Refers High Risk Patients to Social Services: Utilizes Social Work screening criteria to make appropriate social work referrals. Identifies patient/families with complex psychosocial, ongoing medical discharge planning issues, continuing care needs and refers to the social worker.
- Implements Actions to Prevent Readmission: Collaborates with medical staff to recommend referrals for outpatient care, home health or other community agencies as indicated. Provides post-discharge follow-up by conducting or delegating the telephone evaluation of discharge plan. Works with time to establish interventions to manage high utilizers.
- Supports Patient Flow: Intervenes to expedite the completion of diagnostic tests needed to determine disposition, offers alternatives to admission when appropriate, engages in boarder rounds to determine any needed changes in disposition.
- Initiates discharge planning by conducting screenings for social determinants of health and initial discharge planning assessments for patients admitted through the emergency department.
- Maintains knowledge of Federal, State, and other regulatory agency rules and regulations including The Joint Commission, CMS, Medicare, including but not limited to, knowledge of CMS rules regarding Observation status, the 2 Midnight Rule, and Medicare Inpatient Only Procedures.
- Maintains knowledge of continuum of cares resources and provides education and resources relevant to the effective progression of care, utilization of services, appropriate level of care, and safe patient transition to the patient/family and health care team.
- Identifies potential risk management and/or quality issues and works with the healthcare team to resolve such issues or refer them through the Chain of Command structure to the appropriate resource/committee.
Other duties as assigned by management.
Qualifications
- BSN or Bachelor’s Degree in related field or current enrollment in BSN or related Bachelor’s Degree program required.
- Prior clinical experience in care and management of hospitalized patients.
- Experience in acute care utilization, preferred.
- Utilization review or case management training from a professional Case Management organization, preferred.
- RN license required/NJ.
- Case Management certification preferred.
- Excellent communication, negotiation, and conflict resolution skills
- Data and computer skills
- Knowledge of relevant and state utilization review and appeals requirements
- Rapid cycle change or clinical performance improvement expertise
Compensation Range: $93,600 - $159,120 annually
The compensation above reflects the established range from CentraState Healthcare System (CSHS) for this position at the time the job was posted. CSHS considers many factors to determine compensation, including education, experience, skills, licenses, certification, and training. As such, team member compensation may fall outside this range.
Additionally, the compensation range reflects base salary and does not include extra shift rates or incentives tied to quality, productivity, etc., as applicable.
The benefits outlined also reflect CSHS’ policy at the time of posting. Benefits as are made available to other similarly situated team members of CSHS, although participation is at all times in accordance with and subject to the eligibility and other provisions of such plans and programs. CSHS may modify its benefits plans or programs at any time.
CSHS is proud to comply with all pay equity and pay transparency laws.
