Experience Inc. Jobs

Employment Type:

Full time

Shift:

Evening Shift

Description:

Under the general supervision of the RN Care Coordination Manager and 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 appropriate medical necessity criteria including InterQual, Milliman Care Guidelines (MCG) and payor guidelines. Reduces unnecessary admissions to the acute care hospital. Has accountability for recommending correct levels of care (Outpatient Observation vs. Inpatient Admission), attention to the issues presented by readmissions and recommending options for safe discharge. Facilitates timely throughput of emergency room patients to ensure the safe delivery of services to the patient at the most appropriate level of care. Collaborates with Social Work in effort to identify community and other resources necessary for each individual patient and matches the specific needs for continued care that is acceptable by the patient. Assists Social Work with obtaining authorizations for services requiring precertification. Also collaborates with Social Work to ensure appropriate primary care and specialist 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.

• Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.

• Screens all patients presenting to the ED for their admission potential using appropriate utilization criteria (InterQual and MCG) to provide decision support for physicians in determining appropriateness of admissions and needed level of care.

• Recommends correct levels of care (Outpatient Observation vs. Inpatient Admission) with attention to the issues presented by readmissions, non-contracted funders and avoidance of denials and appeals.

• Discusses cases that do not meet applied utilization criteria with the ED medical team and Physician Advisor as needed.

• Participates as needed in obtaining notification and authorization for ED patients who need transfer to specialty units or other services.

• Assists with the interdisciplinary team to formulate and implement a plan of care that addresses the patient’s physical, psychosocial, functional, financial, and educational needs.

• Assists in managing patients who have frequent ED evaluations and refers patient to appropriate clinical setting.

• Assesses patients who do not require acute care to identify and evaluate complex care.

• Facilitates referrals for appropriate community services, including home health and short/long term care facilities, palliative care, and hospice as needed.

• Participates in identifying, collecting, and analyzing data to support clinical care.

• Coordinates the discharge planning process by providing the patient with home health services, transportation, durable medical equipment and education.

• Maintains an awareness of bed status availability in the hospital and community. Knows anticipated admissions/transfers/discharges of ED patients.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran