The Emergency Department Case Manager performs Utilization Management functions to ensure medical necessity and appropriate setting for optimal patient care.This includes review of documentation, orders and results.Works with ED providers regarding documentation that may affect level of care options.May also include obtaining prior authorization for testing, procedures and level of care options/determinations.Works closely with ED providers and staff to assure patient flow, optimal communication, and patient satisfaction.Consults with ED staff to obtain a holistic perspective of the patient's needs and current level of functioning, as well as limitations or barriers.Completes patient assessments to determine physical and psychosocial functioning, community agency utilization and potential discharge planning options.Also screens for readmission risk factors and primary care coordination. Develops discharge planning interventions and options for patients/family with service needs throughout the continuum of care.Must have awareness of and ability to provide appropriate referrals to community agencies for follow up care/services.
Registered Nurse or Licensed Social Worker Required.
Case Management experience preferred for this position.
Ability to communicate in English, both verbally and in writing.