RN Care Manager Emergency Room FTDays

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POSITION SUMMARY

Reporting to the Director of Care Management, the Care Manager isresponsible for managing the continuum of care from admissionthrough discharge for assigned patients.

The role reflectsappropriate knowledge of RN scope of practice, current staterequirements, CMS Conditions of Participation, EMTALA, The PatientBill of Rights, AB1203 and other Federal or State regulatory agencyrequirements specific to Utilization Review and Discharge Planning.

The Care Manager partners with the medical staff, utilizesscientific evidence for best practices, and relevant data to managethe care of the patient over the continuum of care from prehospitalization through discharge.

These activities includeadmission, continued, extended and discharge reviews in allreimbursement categories to determine medical necessity, assurehigh quality of care and efficient utilization of availablehealthcare resources, facilities and services.

This positionrequires the full understanding and active participation infulfilling the Mission of Martin Luther King, Jr.

CommunityHospital. It is expected that the employee will demonstratebehavior consistent with the Core Values. The employee shallsupport Martin Luther King, Jr.

Community Hospital's strategic planand the goals and direction of the quality and performanceimprovement process activities.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Is a role model for the Hospital'sPatient Satisfaction effort when interacting with customers,subordinates and colleagues.
• Collaborateswith the interdisciplinary team participants in team rounds to : facilitate timely care; sssure quality of care throughout the
• hospital stay; and minimize adverse outcomes.
• Initiates appropriate referrals to theinternal interdisciplinary team.
• Communicateswith Admitting or PFS regarding the needs of the patient, payer andprovider are supported within the limitations of the existingindividual benefit structure.
• Communicatesrelevant elements of the health plan benefits.
• Establishes a working diagnosis (DRG) onevery patient at the time of admission to estimate the targetlength of stay or identify the date of discharge for planning andcare coordination purposes.
• Communicatestarget LOS / estimated discharge readiness to physician, patient,family, care team and payor.
• Documents allteam, physician and patient / family communication and concernspertaining to coordination of care and services.
• Screens every patient to identify need forfurther assessment of medical necessity or discharge planning(standard description of which patients are seen).

11. Adheres tothe Care Management Department policies and procedures.

• Participates in the Quality and PerformanceImprovement Plan for the Care Management Department.
• Considers the patient population served,age-specific criteria and the Watson Model of Care in allpatient / family care and interaction.
• UtilizesMilliman Care Guideline's best practices to determine patientdisposition. Collaborates with on site Hospitalists, Intensivists,Laborists and Emergency Department physicians in this process.

POSITIONREQUIREMENTS

A. Education

• Bachelor of Science degree innursing preferred
• Associates degree innursing required

B.Qualifications / Experience

• Minimum ofone (1) to three (3) years of hospital or related experiencerequired. Internals with at least 18 months acute care casemanagement / coordination experience will be considered in lieu ofnursing clinical experience.
• Able to navigateand connect successfully with outside provider networks (HealthPlans, IPA's, and FQHC's).

C.Special Skills / Knowledge

• Bilinguallanguage skills preferred (Spanish) Basic computer skills
• Current California Nursing license
• Current Basic Life Support (BLS)
• Certification in Case Management preferred.
• ED Care Managers : Must complete annualWorkplace Violence Prevention Program / Certificate, per hospitalpolicy, during initial training / orientation but not to exceed 90days from hire / transfer.

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