Welcome to Montage Health’s application process!

Job Description:

The Nurse Case Manager, Emergency Department (ED) 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 Nurse Case Manager collaborates with the patient/family, multidisciplinary team, physicians, community resources and payers to ensure the patient’s progress and level of care is appropriately determined for the emergency episode of care and for the inpatient encounter to ensure that care is performed and facilitated in an efficient and cost-effective manner. This Nurse Case Manager has well developed knowledge and skills in patient status determination (i.e., MCG, InterQual Criteria), in the assessment and care management of patients and families within the ED, inpatient and outpatient settings. The scope of practice includes patient/family assessment and management, resource management, identifying patients appropriate for Inpatient Admission, Observation, or Outpatient status, coordinating alternative sites of care, care facilitation, discharge planning and other related duties specific to the defined patient population. This Nurse Case Manager collaborates with other case managers, social work staff, Admissions, skilled nursing facilities, home health, urgent cares and other physician and administrative leadership staff within the ED, and both the inpatient and outpatient Care Coordination teams. She/he uses knowledge of pathophysiology, pharmacology, and clinical care processes to participate with other clinical staff and physicians in the development of clinical practice guidelines and physician order sets for the purpose of improving quality of care, changing practice, and reducing costs.

The ED case manager is a valuable member of the ED care team who enhances quality of care and safety for emergency patients by identifying at-risk patients and helping the clinical providers to disposition patients to the appropriate level of care. The ED case manager does this by using evidence-based practice, providing discharge options to physicians, identifying, and creating options for high utilizers of ED services, improving patient flow and throughput, and improving outcomes of care by ensuring safe transitions to post-acute care facilities or to home with needed services. ED case managers can also evaluate patients returning to the ED within 72 hours of an initial ED visit or presenting within 30 days of an inpatient stay. These are high-risk and high-cost situations where the expertise of the case manager can be critical to the safe assessment and ultimate disposition of the patient to the appropriate level of care.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: (Other duties may be assigned).

• Screening patients: Determining if an ED patient is appropriate for admission and identifying the right level of care. Initiate contact with the ED/admitting physician. Offer alternative care settings when appropriate. Ensure clinical documentation matches the patient's diagnosis. (symptoms vs. rule-out or actual diagnosis).

• Revenue Cycle Management: Identify payer information.  Communicate with ED provider of risk-based patient. Communication with Aspire UM (if applicable). Will understand health plan benefits and coverage.

• Managing patient flow: Helping patients move through the ED continuum of care, including coordinating tests, treatments, and procedures to prevent delays in alternative sites of care coordination and to reduce ED LOS.

• Transition planning: Helping patients transition to other care settings, such as SNF.

• Building relationships: Connecting patients with community resources, social workers, and other supports outside of the hospital setting.

• Identifying non-medical issues: Uncovering issues such as homelessness, social isolation, financial needs, and unemployment, i.e., Coordinate and collaborate with ED TCM team members or Health Advocates for support and management of identified needs.

• Communicating with patients and families: Informing patients and families about their plan of care, and any changes or issues that arise. Gaining family/ caregiver engagement and support. Providing next steps.

EDUCATION: Current Registered Nurse license (RN) in the state of California. Complete Case Manager Certification (CCM or ACM) within 2 years from date of hire, if not already obtained.

EXPERIENCE:  Minimum two years of current care/case management experience in the Emergency Department as well as two years of patient care experience (Hospital, Home health, Skilled Nursing, Physician Office, or Clinic) and/or training; or equivalent combination of education and experience. Experience and/or knowledge of general healthcare practices, office workflows and medical terminology. Experience with electronic medical record documentation. Outstanding communication skills, both written and verbal. Excellent organizational skills. Proficient with Electronic Medical Records, Outlook, Microsoft Office Word, and Excel. Displays proven ability to positively influence behavior and outcomes. Demonstrates ability to work autonomously and be directly accountable for results.

PREFERRED: Bilingual English/Spanish. Knowledge of Monterey County community resources. Bachelor’s degree in social sciences, social work, nursing, or a related field. Experience working in EPIC EHR. Experience with Medicare, Commercial, ACO and other payor lines of business.

KNOWLEDGE:  The job holder must demonstrate current competencies applicable to the job position.

SKILLS AND ABILITIES:

• Ability to appropriately interact with patients, families, staff, and others.

• Strong people skills to manage sensitive situations and confidential information.

• Excellent interpersonal communication, problem solving and conflict resolution skills.

• Strong clinical assessment and critical thinking skills

• Substantiates activity by documentation that is entered in a clear, concise, organized, and timely manner.

• Uses critical thinking and problem-solving skills effectively. Identifies creative approaches and takes appropriate action as indicated.

• Documents case management, quality, and risk concerns and refers to appropriate departments as applicable for follow up.

• Demonstrates a working knowledge of approved criteria and applies consistently according to inter-rater reliability techniques.

• Must respond sympathetically and maturely to patient needs.

• Ability to tailor information at the appropriate level of health literacy and to interact respectfully with diverse cultural and socio-economic populations.

• Skill in health information management by appropriately charting patient data in EMR.

• Strong computer skills with strong capabilities in MS Office Suite i.e., Outlook, Word, Power Point and Excel

• Ability to function effectively in a fluid, dynamic, and rapidly changing environment.

• Ability to articulate clearly and concisely both verbally and in writing.

• Ability to self-direct in keeping with departmental and organizational priorities.

• Ability to work autonomously and be directly accountable for assignments.

• Ability to work effectively as a team member with physicians and other staff.

• Ability to apply attention to detail and accuracy.

• Meticulous and well organized.

• Ability to manage data and generate reports.

• Meets individual goals set during annual performance review.

• Uses data to drive decisions and plan/implement performance improvement strategies related to clinical care coordination of patients.

• Identifies potential opportunities for cost savings. Evaluate services provided, timeliness and costs; assists in action plan development and implementation as requested/appropriate.

Equal opportunity employer.

Assigned Work Hours:

Varied hours - varied shifts

Position Type:

Pay Range (based on years of applicable experience):

to

The hours employees work determine when a shift differential is paid.