Case Manager-ED
On-siteKingman, Arizona, United States
Job Summary
Screen patients to identify appropriate admission levels, determine medical necessity, and coordinate post-discharge services for ED and pre-access cases. Collaborate with physicians, nurses, and multidisciplinary teams to facilitate safe transitions of care and ensure compliance with payer guidelines. Perform utilization reviews, document assessments, and assist with discharge planning for complex needs including home health, SNF, and DME. Communicate coverage determinations to payers and provide alternatives to admission when criteria are not met. Work evenings and weekends to manage multiple priorities while maintaining accurate documentation in MCG.
Required Qualifications
- Graduate from an accredited school of nursing
- Bachelor's degree in related health/behavioral/social science field
- At least one (1) year acute care setting experience
- Three years sub-acute experience
- RN's must be licensed and currently registered as an RN in the state of Arizona
- BLS through the American Heart Association or American Red Cross
- Minimum of three years varied acute care hospital experience
- Minimum of two years of clinical experience in medical surgical or critical care nursing
- Three to five (3-5) years of recent acute hospital care experience
- One to two (1-2) years of experience in Utilization Management or Case Management
- Three to five (3-5) years of clinical experience in medical surgical or critical care nursing
- Two (2) years of experience in Utilization Management or Case Management
- Certified care manager (CCM) or accredited care manager (ACM)
- Able to handle multiple priorities simultaneously
- Demonstrates strong oral and written communication skills
- Able to manage technical business equipment i.e., phone, fax, computer etc.
Desired Qualifications
- MSN or Master's in related health/behavioral/social field
- Experience in utilization management, case management, discharge planning, and/or quality improvement
- ACMA or CCM
- Knowledge of clinical, social, insurance/financial, and physical factors that must be considered when evaluating how a patient's expected post discharge care needs can be met
- Knowledge of clinical and social factors that may affect the patient's functional status at discharge
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