Case Manager — Emergency Department - Day and Night
Alta Bates Summit Medical Center is San Francisco East Bay's largest private, not-for-profit medical center with a total of 1,082 licensed beds. Each of our campuses has a 24-hour emergency, obstetric and medical/surgical services in both Oakland and Berkeley. At Alta Bates Summit Medical Center, you'll find an environment that reflects the values and mission to support healthy living.
This position manages and coordinates resources necessary and appropriate for the achievement of optimal clinical and financial patient outcomes; Specifically the role of the Emegency Department Case Manager includes all the functions within the evolving core of the Case Manager individualized to each patient. In addition to the obvious function of access, it is primarily twofold: providing utilization management and discharge planning for patients presenting to the ED in need of care. The case manager also works in tandem with the ED healthcare team to problem-solve patient difficulties in the CM arena. In addition, the ED case manager should participate in the orientation of new staff to the ED and serve as a preceptor for case management personnel.
ED specific functions and responsibilities:
- Access: Screening to evaluate for CM needs
- Consults with and takes referrals from ED physicians, nurses, hospitalists, primary care
- physicians (PCP), ED patients and families.
- Responds to outside patient/family calls for follow-up questions
- Identifies high-risk patient through rounding:
- Maintains a list of possible high risk case-types
- Uses ED tracking system, medical record, and demographic information to identify patients needing CM intervention
Uses information systems to:
- Identify patients with frequent ED visits, problem solve, collaborate with T3 and other resources as needed.
- Identify patient returning in 48 hours to ED or 30 days to inpatient
- Consults additional services to complete a safe and effective discharge plan, including physical therapy, social services, palliative care, interpreters, homeless advocates, patient financial services, behavioral health, etc.
- Consults with admitting office and patient financial services to assist with Medicaid and indigent care applications
- Document according to policy
UR process
- Utilization review and management: Determination of appropriate admission status (observation vs. inpatient) using InterQual criteria; providing resources and education to the healthcare team.
- Screen all ED patient to be admitted to determine payer source and appropriate level of care designation
- Work with physicians to assign/order appropriate designation and medical record documentation
- Assess ED patients and identify options other than acute hospital admission when appropriate:
- Screen and refer to acute rehabilitation, long-term acute care hospitals, and nursing homes for admission directly from the ED
- Screen and refer patients for whom treatments could be safely rendered at home with services (e.g., IV antibiotics, low molecular weight heparin injections, wound care, etc.)
- Document according to policy
- Care coordination to pace and support evidence-based practice
- Advocates for the patients' and families' history and story as it relates to the current situation
- Coordinates information need by the healthcare team as needed
- Coordinates family involvement and decision-making as needed
- Assists with patient flow into and through the ED
- Document according to policy
Discharge planning by creating synergy between level of care needed, resources available, and patient choice
- Define what "safe discharge" means for each patient
- Identify patients who are at risk for recurrent visits to the ED
- Develop working relationships with hospital clinics, SCCP, and disease management personnel to improve access to healthcare for the ED population
- Identify and refer new/appropriate ED patients to specialty areas
- Develop working relationships with community health resources to improve outpatient access to healthcare for the ED population
- Track barriers to clinic, PCP, and other access
- Communicate with PCPs and specialty providers to improve consistency with ED care
- Develop and maintain community resource information/handouts for ED patients
- Prioritize and advocate for patients with urgent needs for specialty or primary care following the ED visit
- Help patients obtain a PCP if needed
- Help patients obtain affordable discharge medications
- Document according to policy
Requirements:
Bachelors degree with 3 years clinical experience in an acute or home health setting; or RN with 5 years clinical experience in an acute or home health setting. Valid CA RN license. Minimum 2 years experience in case management, discharge planning, and/or utilization review within the last 5 years. Quality management experience desirable. Emegency Department experience is highly desirable.
