Easter Seals Jobs

Job Type: Regular

Time Type: Full time

Work Shift: Day (United States of America)

FLSA Status: Non-Exempt

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

The role of the RN Case Manager Emergency Department (ED) is to increase patient throughput to the most appropriate level of care while facilitating interdisciplinary care across the continuum. The RN Case Manager ED will assist in identifying patients appropriate for Admission, Observation, or other patient care status. Collaborates with the physician, nursing, patient access/bed management, etc., to ensure appropriate admission to/from all access points based on level of care. Assures/Confirms that linkages to pre /post-hospital services are in place.

Acts as a liaison between attending physicians, Physician Advisors, local sub-acute care facilities, patients, families, and the community. The role includes managing social issues that impact patient classification and discharge from the ED to ensure ongoing medical management of patient care needs. The goal is to collaborate with patients, families, and healthcare providers to promote health and manage illness in a cost-effective and quality-driven manner.

Job Description:

A. UTILIZATION MANAGEMENT :

Perform a 100% review of anticipated admissions utilizing standardized medical necessity criteria to assess for the appropriate level of care assignment. Serves as a resource to patients, physicians, administrators, and hospital employees regarding issues related to patient classification and reimbursement. Utilizes the escalation process to discuss inappropriate observation or anticipated admission cases. Decrease non-emergency utilization and overutilization by patients in the Emergency Department. Provide real-time interventions to prevent delays and ensure compliance and revenue integrity with healthcare regulations Identify documentation opportunities and other quality or payment indicators. Functions as a resource to the Emergency Department communication of new information regarding case management care transitions, managed care, and the continuum of care. Identify tests, procedures, and interventions earlier to advance the care plan. Intervenes with physicians and ancillary departments concerning clinical and utilization issues to ensure optimal patient outcomes.

B. DISCHARGE PLANNING INTERVENTIONS

Works with Social Work to manage social issues that impact patient classification and discharge from the Emergency Department. Prevent unnecessary admissions. Function as a liaison between the Emergency Department and community-based resources on an as-needed basis. Assist in discharge planning (referrals) for individuals with continuum of care needs (Home Care, Hospice, etc.). Provide assessment, brief counseling, information, referrals, and other resource assistance to patients/family as needed. Facilities treatment, admission, discharge, and/or transfer in collaboration with the physician and primary nurse. Identify high-risk social situations to intervene in and coordinate resources to promote follow-up care. Initiate early discharge referrals and placement into Skilled Nursing Facilities, Acute Rehabilitation, etc. Communicate with Care Transitions colleagues about incoming patients with discharge planning needs. Works collaboratively with Social Workers to assess, coordinate, and refer cases of suspected/actual abuse, domestic violence, or neglect to appropriate agencies. Precertification of services for discharge as needed. Arranges for community services before discharge to meet patients’ post-discharge needs with recognition and documentation of patient choice of service providers. Identifies potential quality & risk management issues based on acceptable standards of practice and refers cases to Care Transitions leadership to ensure the quality of patient care and prompt identification of potential problems. Documents Case Management notes briefly and concisely. Advocates for the patient/family with other health care professionals and community agencies as indicated to enable them to negotiate various social systems.

C. MISCELLANEOUS JOB FUNCTIONS

Participates in Care Transitions or other projects according to departmental and organizational monitors. Performs basic administrative tasks related to the job as required by the Care Transitions Department policy and procedure to maintain accurate records and to ensure worker accountability/productivity. Maintains a highly acceptable level of professional conduct and respect for medical staff, coworkers, and hospital staff to foster a desirable image for the institution. Compliant with all hospital/departmental policies/procedures assigned by the department manager, including work hours, scheduling, and other criteria for the expected daily operations of the department. Maintains strict confidentiality in dealing with all patient-related activities and other sensitive physician and/or hospital issues by strictly adhering to hospital confidentiality of information policies. Facilitates open communication and good working relationships with Bed Management and/or Transfer Center to promote and enhance efficient operations within Care Transitions. Acknowledges budgetary constraints in department operations and strives to perform duties cost-effectively and efficiently. Demonstrates ability to prioritize multiple work assignments to accomplish the assigned workload. Abides by all hospital/departmental policies and procedures assigned by Care Transitions leadership, including work hours, scheduling, and other criteria for the expected daily operation of the department. Performs other duties as may be assigned to ensure that departmental objectives are fulfilled.

Reports To: Care Transitions Leadership

Education:

Required: Current RN licensure, State of Massachusetts, BLS

Preferred: Bachelor’s degree in Nursing or another healthcare-related field, experience in standardized medical necessity criteria

Certifications :

Preferred: ACM, CCM or CMAC

Experience:

Required : Three years of acute care experience

Preferred: Case Management or Utilization Management experience

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more (https://www.bilh.org/newsroom/bilh-to-require-covid-19-influenza-vaccines-for-all-clinicians-staff-by-oct-31) about this requirement.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled