ER CASE MANAGER/RN - CASE MANAGEMENT
ER CASE MANAGER/RN - CASE MANAGEMENT
The Times-Picayune | Nola.com
Hammond, LA
See who The Times-Picayune | Nola.com has hired for this role
Status: Full Time
Shift: 7a-7p with rotating weekends
Exempt: No
Other Information
Expert knowledge of InterQual Level of Care Criteria or Milliman Care Guidelines and knowledge of local and national coverage determinations.
ACM or CCM certification preferred.
Pull: occasionally Carry: occasionally
Lift: occasionally Sit: frequently
Stand: frequently Walk: frequently
Responsibilities
Provides initial utilization review for emergency room, surgical, and direct admit patients
Shift: 7a-7p with rotating weekends
Exempt: No
Other Information
- Previous Experience Required
- Specialized or Technical Education Requirements
Expert knowledge of InterQual Level of Care Criteria or Milliman Care Guidelines and knowledge of local and national coverage determinations.
ACM or CCM certification preferred.
- Manual or Physical Skills
- Physical Effort Required
Pull: occasionally Carry: occasionally
Lift: occasionally Sit: frequently
Stand: frequently Walk: frequently
Responsibilities
Provides initial utilization review for emergency room, surgical, and direct admit patients
- Screens Emergency Room admits, direct admits and transfers from other facilities to the ED to ensure medical criteria for admission is met.
- Performs initial clinical review on patients being admitted, and documents reviews and pertinent findings based on nationally recognized clinical guidelines.
- Reviews the surgical scheduling list to identify appropriate pre-authorization for level of care should patient be scheduled for acute hospitalization.
- Communicates outcome of admission screens based on established criteria clinical guidelines for medical necessity to the Medical Staff as necessary.
- Provides recommendations for alternative levels of care when appropriate, based on established clinical practice guidelines.
- Reviews admission orders for all patients being admitted during shift.
- Serves as an information resource regarding insurance benefits and coverage to patients, caregivers, hospital, and Medical Staff on patients being admitted.
- Refers cases which do not meet established admission criteria to dept. Supervisor, Coordinator, Director, and/or Chief Medical Officer or Medical Director. Manager or physician advisor.
- Serves as “on-call” Case Manager for the hospitals after normal business hours. Manages inter-facility transfers, direct admissions, and status changes during this time. Refers requests for post-discharge referrals to community agencies to the Social Worker II assigned to the ER when present.
- In the absence of a Social Worker, assesses and documents patient’s psychosocial and discharge planning needs and collaborates with the physician for further treatment and discharge/transfer planning.
- In the absence of a Social Worker, makes appropriate referrals to discharge planning, continuum of care, abuse, neglect and/or exploitation with all necessary information to other agencies/resources to ensure continuity of care. Works to place PEC/CEC patients for psychiatric treatment needs.
- Follows North Oaks Health System’s Compliance Programs and Federal and State Regulatory guidelines.
- Follows North Oaks Health System Infection Control guidelines and practices.
- Follows North Oaks Health System guidelines and practices related to HIPAA.
- Other duties as deemed necessary and appropriate.
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Seniority level
Entry level -
Employment type
Full-time -
Job function
Management and Manufacturing -
Industries
Broadcast Media Production and Distribution
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