ER Case Manager
March 24, 2023 |
Department: Case Management
Status/Schedule: Full Time
Shift: Days
Location: Hartford, KY
For more information contact: Michelle Hickerson, mhickerson@ochcares.com
Qualifications:
- Education: RN required; BSN preferred
- Experience: Previous acute care experience; previous case management experience
- Additional Requirements: Experience with E-Clinical Works a plus
Job Description:
- Implementation of CM in the ER.
- Work with ER physicians and hospitalists to screen for admission criteria
- Utilization of InterQual criteria to determine appropriate level of care, facilitate necessary transfers out of ER
- Referrals to community resources as needed including home health and nursing home placement, and aid hospitalist staff in relation to admission of patients.
- Admission reviews for both federal and non-federal patients utilizing approved criteria.
- Conducting continued stay reviews for both federal and non-federal patients utilizing approved criteria.
- Application of Condition Code 44 per CMS guidelines.
- Demonstrates knowledge of various levels of care offered in the facility. These include the following: Acute/Inpatient, Observation, Outpatient Surgery Observation, Swing Bed, Critical Care and IVT.
- Demonstrates effective critical thinking skills and problem solving with difficult patient situations to foster positive outcomes.
- Maintains all required documentation and retention of records as outlined in facility policies.
- Identification of potential abuse and neglect and compliance with reporting standards.
- Demonstrates knowledge of regulatory standards that apply to the area of practice in Case Management.
- Effective communication with staff, physicians, patients, families and visitors and all community agencies.
- Performs admission assessments on patients of Ohio County Healthcare and initiates discharge planning at the point of assessment. Risk assessment performed for potential environmental hazards to patient.
- Assessment of all Private Pay patients and assistance with resource navigation.
- Understands and maintains compliance with the MOON notice per CMS guidelines.
- Understands and maintains compliance with the Important Message from Medicare per CMS guidelines.
- Understanding of Medical necessity precertification process for outpatient infusion and injection patients.
- Maintains strong working relationships with Community Health, Welfare and Social agencies.
- Participates in opportunities for continuing education and professional self-development.
- Maintains a current license in the state of Kentucky.
- Assures proper and timely documentation in patient medical records.
- Serves as a liaison between Ohio County Healthcare and community agencies on behalf of the patient to provide continuity of care after facility discharge.
- Maintains confidentiality in all patient records and interactions.
