ID: 71654225

Shift: REMOTE (can be worked in any state)Saturdays only from 8-4:304 month expected duration (coverage

Description: Job Summary: -The Emergency Department Case Manager Weekend (EDCM) is responsible for assessing, planning, implementing, monitoring and evaluating options and services to create an individualized care plan for patients in the Emergency Department (ED) and across the continuum of care. -The EDCM ensures timely transition of patients to the optimal level of care, makes recommendations to the Interdisciplinary Care Team, and coordinates post-ED care by effectively collaborating with patients, families, physicians, nursing staff, and other healthcare providers. -The EDCM utilizes clinical knowledge, communication, problem-solving, conflict resolution, assessment, organization, and time management skills to drive optimal patient outcomes while considering financial and health plan resources. -The EDCM monitors ED utilization trends, ensures connection with appropriate resources, documents in Cerner, verifies medical necessity and insurance compatibility, and uses MCG criteria to assess care levels. -The EDCM coordinates facility transfers, ensures hospitalizations are appropriate and contracted, adheres to departmental policies, and provides support to inpatient colleagues as needed. -The EDCM reports to the Inpatient Case Management Supervisor or designee. Job Responsibilities: -Applies MCG criteria to monitor appropriateness of admissions, level of care, and continued stays. -Documents findings and interventions in Cerner based on departmental standards. -Manages patient care through the ED and healthcare systems based on individual needs. -Collaborates with physicians, Social Services, and healthcare providers for care plan changes. -Advocates for patients and families throughout the care episode. -Remains available to patients/families to facilitate communication among providers. -Develops individualized comprehensive care plans with physicians, Social Services, and the interdisciplinary team. -Continuously assesses and reassesses patients, updating discharge plans as needed. -Transitions patients to the next level of care and involves appropriate outpatient resources. -Transfers case management function using SBARQ format when needed. -Coordinates patient transfers using health plan knowledge and MCG criteria. -Initiates and facilitates outpatient referrals to prevent inappropriate hospital admissions. -Applies knowledge of cultural, psycho/social, developmental, and age-specific factors. -Maintains knowledge of federal, state, and local regulations. -Acts as a resource for physicians and staff on utilization management and care options. -Communicates with health plans and acts as a liaison regarding insurance and discharge planning. -Identifies high-risk patients and communicates with Readmissions Case Manager. -Evaluates case management impact on outcomes and develops strategies for improvement. -Utilizes problem-solving and conflict resolution to develop effective care plans. -Initiates regulatory forms and letters to ensure compliance. -Completes timely assessments, documentation, and reports. -Interacts with the healthcare team to ensure appropriate post-ED/hospital plans. -Informs patients/families about financial implications related to care plans. -Maintains confidentiality of patient and electronic data as per regulations. -Keeps current on organizational policies, regulations, and legislative changes. -Documents utilization data and discharge planning in Cerner. -Refers patients using high-risk screening criteria to appropriate follow-up services. -Hands off information to inpatient case managers using SBARQ format. **See Attachment for Full Job Description** Schedule Notes:REMOTE (can be worked in any state)Saturdays only from 8-4:304 month expected duration (coverage for maternity leave)start date for this vacancy would begin October 9th with an orientation date of 10/9 10/11, 10/18 and start every Saturday thereafter on 10/25Requirements:oCA RN licenseo3 years of nursing experienceo2 years of case management experienceJob description is broad, but utilization review is the main focusoUR using MCGSkills: Required Skills & Experience: -Basic knowledge of personal computers and word processing software. -Good keyboard skills. -Ability to enter and retrieve data from relevant computer systems. -Competence in Microsoft Office programs including Outlook and Word. -Knowledge of Medicare rules and regulations and Conditions of Participation. -Knowledge of Joint Commission and Department of Health organizational standards. -Knowledge of acute care, home care, subacute care, long-term care, hospice, rehabilitation options, and community resources. -Understanding of medical necessity guidelines and quality assurance processes. -Ability to determine positive outcomes and understand healthcare trends and best practices. -Familiarity with management tools and related healthcare literature. -Minimum of Three (3) years of acute clinical nursing experience. Preferred Skills & Experience: -Experience with MCG. -Experience with Cerner. -Experience with PowerPoint. -Emergency Department experience. -Minimum of Two (2) years of case management experience.Education: Required Education: -Graduate of an accredited nursing school or college. -Bachelor of Science in Nursing (BSN). Preferred Education: -Master of Science in Nursing (MSN). Required Certifications & Licensure: -Current California state Registered Nurse (RN) license. Preferred Certifications & Licensure: -Certified Case Manager (CCM).OR-Accredited Case Manager (ACM).Job Category: Clinical Nursing Travel

Guaranteed Hours: 8.00

Contract Weeks:124