Under the general supervision of the 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 InterQual criteria. Reduces unnecessary admissions to the acute care hospital. Has accountability for assigning correct levels of care (Outpatient Observation vs. Inpatient Admission), attention to the issues presented by readmissions and recommending options for safe discharge. Coordinates all non-elective point of entry admissions (including direct admissions and SPU) and facilitates timely throughput of emergency room patients to ensure the safe delivery of services to the patient at the most appropriate level of care. Responsible for identifying community and other resources that are necessary for each individual patient and matches specific needs for continued care that are acceptable to the patient. Identifies services that require authorization and collaborates with payers to obtain needed authorizations for services. Ensures patient has a primary care 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.
Education and Training
BSN or BA in Nursing. Enrolled or committed to enroll in a BSN or BA in Nursing program, making steady progress towards degree.
Certification and Licensure Registered Nurse licensed in the State of Pennsylvania Case Management certification from an accredited organization preferred.
Skills • Managed care, government payers, third-party reimbursement • InterQual criteria and its application • Information systems, Midas preferred • Using MS Office applications • Developing and maintaining strong interpersonal relationships • Oral and written communication skills • Ability to document in an electronic health record completely and accurately
Experience Three (3) years of utilization management or case management experience, including emphasis on discharge planning.
Additional Salary Information: Varies based on expereince
Mercy Health System is dedicated to providing easily accessible, patient-centered, compassionate health care. Building on our 100 year foundation of caring, we achieve our mission through our commitment to the overall health of the communities we serve. Our centers of health care excellence address the unique and diverse needs of these communities. Rooted in our core values, Mercy Health System, i...ts facilities and affiliates offer access to quality medical care, delivered by compassionate, highly trained health care professionals to all in need. If you are an individual who is mission driven and who wants to make a difference in the lives of others, we invite you to join us. We know our colleagues are our core strength and that each contributes to our ministry of quality and compassionate care.
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