Case Manager - E.D.
Boca Raton Regional Hospital - Boca Raton, FL

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- American Heart Association BLS
- Current FL RN license
- 2 or more years related experience required
- Hospital experience required

Position Summary:


Applies advanced clinical skills to facilitate the management of the patient experience through the assessment, planning, intervention and evaluation of effective utilization of resources using current clinical knowledge, awareness of community services and functioning as a role model to achieve optimal clinical and resource outcomes. Primary responsibilities will be related to the Emergency Department . Experience in In-patient setting strongly preferred. **$3,000 sign-on bonus for the ED position**

Position Expectations and Responsibilities:
  • Expected to have the ability to read, analyze and interpret general business periodicals, professional journals, technical procedures of governmental regulation.
  • Expected to have basic mathematical skills.
  • Expected to have basic computer knowledge and be able to use or have the ability to learn any software or systems utilized within the department.
  • Expected to initiate case management review within established policies, procedures and time
    frames.
  • Expected to work with the physician, nursing/medical staff, social worker, patient/family and community resources to formulate and continually reevaluate a plan of care that best meets the needs of the patient.
  • Expected to communicate with physician daily and conduct rounds within nursing/patient care units to observe, intervene, plan and evaluate the implementation of the discharge plan.
  • Expected to confer and works collaboratively with medical/nursing, social worker, patient/family and community resources regarding aspects of patient needs, in compliance with MEDICARE standards and promoting patient/customer satisfaction to coordinate and implement case management services.
  • Expected to review and report patients with Length of Stay (LOS) greater than 10 days to director to monitor for appropriateness of acute care based on Intensity of Service and discharge plan.
  • Expected to provide data for research and administrative support for case management operations, special projects and studies.
  • Expected to provide clear, concise, timely written documentation and update information and computer data as required.
  • Expected to participate in PI processes.
  • Expected to review medical records of inpatient and observation patients on the day of admission or the first working day following admission, to determine medical necessity and appropriateness of admission or observation status.
  • Expected to obtains certification of admission and/or continued stay when documentation in the medical record is appropriate and the case is determined to be medically necessary, in accordance with established criteria.
  • Expected to document rationale for case determinations and next review date.
  • Expected to screen ED patients for admission criteria (medical necessity/patient status/level of care)
  • Expected to screens potential transfers from outside hospitals/facilities for appropriateness of admission and medical necessity.
  • Expected to communicate results of screening to attending physician if orders don't match level of care ordered.
  • Expected to communicate results of screening to bed control/registration.
  • Expected to coordinate delivery of HINN (Hospital Issued Notice of Non-coverage)
  • Expected to documents initial screening criteria in Canopy.
  • Expected to assist with disposition of medically complex patients (i.e. shelters, rehab).
  • Expected to review chart or orders for appropriate order status.
  • Expected to educate medical staff, nursing staff on compliance related topics, admission status, quality indicators, and medical necessity.
  • Expected to assist with transfers out of the Emergency Department.
  • Expected to document criteria review in Canopy.
  • Makes referrals as appropriate to social worker and financial counselor.
  • Expected to write reports, business correspondence and procedure manuals.
  • Expected to effectively present information and respond to questions from groups of managers, clients, customers and the general public.
  • Expected to collaborate with physicians and the interdisciplinary team to identify possible clinically-related discharge needs.
  • Expected to communicate with patient/caregiver and physician regarding any issues related to payor or financial issues which may negatively influence the patient's post acute care plan.
  • Expected to actively participate in the education of healthcare team members on current healthcare economic issues impacting practice patterns, reimbursement and positive patient outcomes.
  • Expected to communicate all discharge plans and options to patient/family, physicians and staff members.
Minimum Education and/or Experience Required:
  • Associate's degree in from an accredited school of nursing, BS or BSN preferred AND Minimum of three years experience in a current acute care clinical setting (preferred)
Licensure/Regulation/Certification:
  • Current Florida Licensure as Registered Nurse, Certification in Case Management/Utilization Management preferred
  • BLS certification from the American Heart Association
*Incumbent may be required to perform emergency duty before, during and/or beyond normal work hours in the event of an emergency, crisis situation or disaster (man-made or natural) including evacuation sites.

*The person in this position will work in a smoke-free location, and is expected to adhere to all smoking restrictions.

*In the spirit of wellness for both our employees and patients, Boca Raton Regional Hospital has instituted a mandatory influenza prevention vaccination program. Current employees must receive the influenza prevention vaccination free of charge during the recognized flu season. As a condition of employment, new hires will be required to comply with all program rules. This is a mandatory program with the exception of documented medical or religious reasons for not receiving the vaccine. For further information on this progressive program, please contact Boca Raton Regional Hospital ’s Human Resources Department at 561-955-4075.

Boca Raton Regional Hospital - 15 months ago - save job - block
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