Department

CARE MANAGEMENT - 258410

Worker Sub Type

Regular

Work Shift

First Shift (United States of America)

Pay Grade

135

Job Description

The Emergency Department (ED) RN Case Manager is responsible for establishing, coordinating, and maintaining the process to increase patient through-put to the most appropriate level of care while facilitating interdisciplinary care across the continuum for the ED. The RN Case Manager responsible for the management of admission flow efficiency through appropriate patient status DRG/LOS assignment, and timely patient progression to achieve system efficiency. The RN Case Manager is a position that serves as the primary liaison between the emergency department, nursing units, ancillary departments, and in partnership with physicians to ensure patient care needs are met and treatment plans are executed timely. The RN Case Manager leads and collaborates with members of the healthcare team to improve patient throughput and LOS performance of the organization.

Responsibilities and Duties:

Assesses patients' clinical presentation against Milliman Care Guidelines (MCG) to identify admission status, working DRG and target LOS; communicates recommended status to physician; validates admission order matches determined status and level of care.

Collaborates with ED and Hospitalist providers/clinicians to proactively evaluate appropriateness of potential admissions (i.e. status, level of care); evaluates alternatives for patients not meeting admission criteria.

Assesses patient discharge needs (for patients not meeting admission criteria); Collaborates with physicians and ancillary services (i.e., PT, OT, Social Work) when indicated to ensure a comprehensive discharge plan that addresses patient needs, barriers, and readmission risk.

Communicates plan of care and discharge plan to patient and/or their family in coordination with the patient’s primary care team (RN, physician).

Evaluates and identifies cases where status discrepancy requires physician level review; escalates case through appropriate venue for review and status determination.

Consults and educates medical and nursing staff regarding status, placement, payor requirements, patient progression and care coordination.

Communicates and coordinates patient admission activities with floor care managers and social workers to facilitate system-wide planning; ensures appropriate patient placement, level of care, patient progression, and patient flow.

Participates in ED huddles (RN, physician, ancillary staff, and social work) to discuss ED holds to ensure care team alignment on progression of care; identifies and escalates barriers to leadership as appropriate.

Proactively identifies and removes barriers that may impede department or system-wide patient flow.

Assists with system-wide ED case management consults after hours and weekends.

Social Determinants of Health (SDOH) Assessments.

Other Duties as assigned.

Education

Bachelor's Nursing (BSN) is required

Masters Nursing (MSN) is preferred

Graduate of an accredited school of nursing is required

Experience

Minimum five years of professional practice experience in an acute care setting is preferred

Prior Case Management or Utilization Management is preferred

Clinical experience in critical care or emergency nursing strongly is preferred

Certification & Licensure

Licensed as a Registered Nurse in the State of Virginia is required

BLS Certification (Basic Life Support) -American Heart 'Healthcare Provider' (HCP) - AHA approved is required. * New hires must have American Heart Association (AHA) appropriate certification prior to completion of orientation.

Certified Case Manager (CCM) or Accredited Case Manager (ACM) certification is required within (4) years of hire

Qualifications

Excellent written/verbal communication and interpersonal skills with all levels of internal and external customers, critical thinking skills, creative problem solving, proficient organization, and planning

Must be self-­ directed and have the ability to tolerate frequent interruptions and a demanding workload

Knowledge of funding, resources, services, clinical standards, and outcomes is preferred

Demonstrated ability to be creative, innovative, and flexible in responding to rapidly changing needs and priorities

Benefits

At Valley Health, we believe everyone is a caregiver, and our goal is to create an environment where our caregivers thrive physically, financially, and emotionally. In addition to a competitive salary, our most popular benefits for full-time employees include:

• A Zero-Deductible Health Plan
• Dental and vision insurance
• Generous Paid Time Off
• Tuition Assistance
• Retirement Savings Match
• A Robust Employee Assistance Program to help with many aspects of emotional wellbeing
• Membership to Healthy U: An Incentive-Based Wellness Program

Valley Health also offers a health savings account & flexible spending account for childcare, life insurance, short-term and long-term disability, and professional development. In addition, several perks come with working for the largest employer in the region, such as discounts to on-campus dining, and more.

To see the full scale of what we offer, visit valleyhealthbenefits.com.