APPENDIX K

CASE MANAGER–EMERGENCY DEPARTMENT
Job Description
 JOB TITLE: Case Manager (Emergency Department)
 DEPARTMENT: Case Management
JOB SUMMARY: The case manager is responsible for facilitating the patient's hospitalization from preadmission through discharge. The case manager interfaces with physicians, nurses, social workers, and other healthcare team members to expedite medically appropriate cost-effective care. The case manager applies clinical expertise and medical appropriateness criteria to resource utilization and discharge planning.
REPORTS TO: Director of Case Management
 SUPERVISES: Case Management Support Staff
RESPONSIBILITIES:
  1. Facilitates and expedites the discharge of patients from the emergency department to alternate care settings using established criteria.
  2. Facilitates the initiation of diagnostic services, treatment planning, and therapeutic treatment while patient is present in the emergency department of admitted patients.
  3. Collaborates with social worker on referrals to alternate levels of care.
  4. Collaborates with emergency department physician advisor when unable to resolve issues with the attending physician.
  5. Collaborates in the development of clinical practice guidelines and critical pathways for designated targeted diagnosis to ensure staff buy-in.
  6. Consults with physician advisor(s), emergency department nursing staff, and staff in the ancillary departments to eliminate barriers to efficient delivery of care.
  7. Initiates a mechanism to facilitate communication with other case managers on admitted and observation patients.
  8. Identifies issues of clinical resource utilization and/or delays in service/care (based on service standards) with the emergency department staff and refers these issues to the appropriate department head/vice president for resolution.
  9. Serves as the first-line clinical responder to payer's clinical questions as required for payer approval for admission/observation.
  10. Reports to the emergency department chairman all potential compensable events that need to be reported to risk management.
  11. Employs a high degree of skill in all oral and written communications and personal interactions and demonstrates collaborative working relationships.
  12. Uses appropriate resources and methods to resolve conflict with others.
  13. Meets assigned deadlines and quality standards without reminder from supervisor or others.
  14. Maintains a calm, rational, professional demeanor when dealing with others, even in situations involving conflict or crisis.
  15. Maintains absolute adherence to hospital and departmental policies and practices regarding confidentiality and patient's rights.
  16. Demonstrates knowledge and support of the hospital's mission and values.
  17. Maintains clinical competency and current knowledge of regulatory and payer requirements to perform job responsibilities.
SKILLS/QUALIFICATIONS: Licensed as a registered nurse. Baccalaureate degree preferred. At least 5 years of clinical experience as a registered nurse. Leadership experience preferred. Utilization review of discharge planning experience preferred.