Employment Type:Full timeShift:Evening Shift

Description:Under the general supervision of the RN Care Coordination Manager and Director of Care Coordination, the Emergency Department Care Manager assists physicians and the interdisciplinary team in facilitating the entry of patients into the appropriate level of care utilizing appropriate medical necessity criteria including InterQual, Milliman Care Guidelines (MCG), and payor guidelines. Reduces unnecessary admissions to the acute care hospital. Has accountability for recommending correct levels of care (Outpatient Observation vs. Inpatient Admission), attention to the issues presented by readmissions, and recommending options for safe discharge. Facilitates timely throughput of emergency room patients to ensure the safe delivery of healthcare services to the patient and at the most appropriate level of care. Collaborates with Social Work in effort to identify community and other resources necessary for each individual patient and matches the specific needs for continued care that is acceptable by the patient. Assists Social Work with obtaining authorization for services requiring precertification. Also collaborates with Social Work to ensure appropriate primary care and specialist physician follow up. Collaborates with the ED healthcare team to determine the treatment plan, while observing quality and patient safety parameters, LOS, readmissions, and risk for denials and appeals.Knows, understands, incorporates and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisionsScreens all patients presenting to the ED for admission potential using appropriate utilization criteria (InterQual and MCG) to provide decision support for physicians in determining appropriateness of admissions and needed level of careRecommends correct levels of care (Outpatient Observation vs. Inpatient Admission), with attention to issues presented by readmissions, noncontracted funders and risk of denials and appealsDiscusses cases that do not meet applied utilization criteria with the ED medical team, admitting team and the Physician Advisor as neededParticipates as needed in obtaining notification and authorization for ED patients who need transfer to specialty units or other servicesAssists the interdisciplinary team to formulate and implement a plan of care that addresses the patient’s physical, psychosocial, functional, financial, and health education needsAssists in managing patients who have frequent ED evaluations and refers patients to appropriate clinical settingAssess patients who do not require acute care to identify and evaluate complex care needsFacilities referrals for appropriate community services, including home health and short/long term care facilities, palliative care, and hospice as neededCoordinates the ED discharge planning process by providing the patient, when clinically indicated, with home health services, transportation, durable medical equipment, and appropriate educationMaintains an awareness of ED status availability Participates in identifying, collecting, and analyzing data to support clinical care

Our Commitment to Diversity and Inclusion
 

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.