Emergency Department Case Manager RN

POSITION SUMMARY

Functions independently and collaboratively to assure appropriate utilization of resources for patients across the continuum of care. The Emergency Department (ED) Case Manager RN is an integral member of the ED care team who provides strategic guidance to the department clinical and operations staff for the purpose of assuring that patients are placed in the correct level of care without ambiguity in the orders or treatment plan. The case manager understands the nature of ED care and patient flow, and the special demands placed on the ED staff due to high volume, fast turnover and patient/family expectations. The ED Case Manager evaluates patients that will remain in the hospital and completes the initial InterQual assessment and assists with outpatient follow-up plans for patients that will be discharged from the ED. ED CM is responsible for assessing behavioral health patients and collaborating with the ED physician to determine the patient’s safety risk, correct level of care and voluntary/involuntary status. ED CM communicates with family members and other pertinent individuals to gather necessary information for each patient to insure the best outcome for the patient. ED CM understands the nature of ED care and patient flow as it relates to behavioral health patients.

MINIMUM REQUIREMENTS

Education

• Completion of an accredited registered nurse program required; BSN preferred.

Experience

• Two years current health care experience required, preferably in acute care.
• Preference is given to previous psychiatric experience, utilization management experience and care protocols experience.

Knowledge, Skills, Abilities

• Knowledge of hospital admitting procedures, health care legislation and government/regulatory health related agencies.
• Demonstrates an ability to communicate effectively and express ideas clearly; actively listens; works well with others to solve interpersonal conflicts and problems without need of superiors. Demonstrates ability in collaborating with physicians. Requires excellent communication skills to work collaboratively with all members of the health care team.
• Demonstrates an ability to identify and solve problems. Demonstrates critical thinking skills.
• Computer skills are required.

License/Certification/Registration

• Current Pennsylvania Registered Nurse license.
• Meets the American Heart Association’s standards for Healthcare Provider Basic Life Support (BLS) and renews BLS every two years.

SUPERVISION RECEIVED

Receives minimal supervision from the Supervisor Case Management. Functions independently; seeks guidance when necessary.

SUPERVISION GIVEN

None

ESSENTIAL FUNCTIONS

• Performs review prior to admission on all patients admitted through the Emergency Department and directs urgent admissions for medical necessity and appropriateness of admission based on approved criteria. If criteria is not met, makes suggestions regarding whether observation status or discharge is most appropriate. May suggest alternative placement, especially in those cases that the family expects the patient to be admitted.
• Facilitates and coordinates appropriate community resources and services for patients that are discharged from the Emergency Room.
• Screens each admission based on discharge planning criteria in a timely manner; determine, in collaboration with others, whether discharge planning is simple or complex.
• Reviews complex discharge plans with other care managers.
• Initiates daily discharge planning team encounters as necessary.
• Formulates appropriate discharge plan with patients/family. May make recommendations for services such as life alert systems, referral to area agency on aging, etc.
• Ensures timely, coordinated access to appropriate levels of care, support services, and continuity of care.
• Maximizes the appropriate use of personal and internal resources.
• Links the patient to community and formal resources as needed.
• Reviews appropriate patients with DME providers, home health liaisons, rehab liaisons, nursing home representatives, personal care home providers, and other community service providers, as needed.
• Identifies and resolves barriers that hinder patient care-may provide resources to families such as respite care, support groups.
• Assesses psychosocial factors of patients/families, including those in crisis, through interview and other means and formulation of documented treatment plan.
• Sees patient consults within appropriate time frame, documents same at time of consult; prioritizes consults utilizing designated standards.
• Interprets psychosocial factors to physicians and other caregivers.
• Facilitates understanding of medical recommendations.
• Engages and mobilizes patient and family coping strengths.
• Educates patient and family regarding risk factors for optimal psychosocial function.
• Counsels patients/families regarding illness, discharge plans, death and levels of care including long term placements as assigned.
• Promotes quality patient care and effective use of resources.
• Consistently demonstrates an ability to assess a situation from a variety of perspectives, consider several alternatives, and choose an appropriate course of action.
• Pursues opportunities to improve patient care and resolve identified issues or problems.
• Recognizes continued need for containment of costs without jeopardizing quality of patient care.
• Obtains and analyzes all pertinent information available to make the most informed decision based on factual and objective data.
• Develops, in collaboration with other health care providers, pathways/guidelines/protocols for care of patients.
• Uses initiative and good judgment to reach quality decisions.
• Maintains knowledge of resources and facilities available to patients and families.
• Recognizes age and culturally relevant considerations.
• Conducts comprehensive mental health evaluation of behavioral health patients in the ED of all ages including children, adolescents and geriatric populations.
• Case Manager acts as a point of contact for all behavioral health patients in the ED including children, adolescents and geriatric populations.
• Explains the behavioral health procedures in the ED to the patient upon arrival, including the necessity and process of medical clearance.
• Obtains health and social information through interview process, assessment, and data collection.
• Collects information regarding patient’s immediate crisis from law enforcement, family members and mental health professionals or agencies involved in current crisis.
• CM does not assess patients who appear to be under the influence of substances other than alcohol until they are able to appropriately participate in the assessment.
• Assesses patient’s safety risk/elopement risk and communicates this to RN caring for patient.
• Assesses patient’s suicide risk via a comprehensive suicide assessment.
• Provides therapeutic stabilization reducing patient escalation.
• Keeps patients informed of progress during their time in the ED.
• Provides therapeutic interventions such as diversional activities when appropriate.
• Works closely with ED physician to determine need for inpatient hospitalization or outpatient referrals.
• Works closely with ED physician to determine patient’s commitment level - 201 (Voluntary); 302 (Involuntary).
• Collaboration with the psychiatrist and 3 South Liaison.
• CM provides comprehensive documentation.
• CM acts in accordance with ACT 147 when working with adolescents age 14-18.
• CM abides by Duty to Warn laws when it is appropriate.
• Completes 302 Involuntary Commitments
• Collects petitioning statements.
• Contacts CCR at 800-643-5432 to request a delegate through Sam, Inc. to issue 302 warrants based on petitioning statements indicating the patient poses and clear and present danger of harm to others or him or herself.
• Box B -Ensures patient is read their rights in accordance with an involuntary commitment.
• Box B -Secures patient’s personal belongings via family member or friend for duration of 302 commitment.
• Box B – Conducts comprehensive bed search to secure placement.
• Provides support and collaborates with the ED physicians regarding 302 commitments.
• Assures that all 302 paperwork is completed properly and forwarded to appropriate agency.
• Facilitates and coordinates appropriate inpatient placement or outpatient services
• Inpatient Hospitalization
• Conducts a bed search to find appropriate placement for patient.
• Makes referrals to appropriate facilities: faxes lab results, doctor’s notes, mental health assessment and any other information requested by the facility.
• Completes 201 commitment for accepting facility.
• Arranges transportation to accepting facility.
• Completes transfer paperwork in conjunction with ED physician.
• Completes insurance precertification when required.
• Patients discharged home
• Before discharge PCM completes a safety plan with the patient.
• Ensures that all necessary Release of Information forms are signed by patient.
• Ensures continuity of patient’s care and effective communication among the patient’s physicians, mental health professionals and agencies.
• Makes necessary referrals to outpatient providers and agencies such as PSU CAPS, Outpatient Therapist, Centre Co MHID, and Psychiatry.
• Follows up with patient’s current providers and makes appointments when needed.
• Follows up with patients within 1-2 days following discharge to ensure continued safety.
• Acts as a liaison among ED Physicians, Psychiatrist, ER Clinical Supervisor, patient’s family, external agencies and providers.
• Facilitates understanding of behavioral health recommendations and procedures to patient’s family.
• Provides education for physicians regarding medical documentation needed to facilitate treatment plan.
• Communicates with medical staff (Attending RN, Clinical Supervisor Nurse) regarding ongoing progress and disposition of patients.
• Communicates with patient’s family when appropriate regarding final disposition of patient.
• Identifies educational needs within the ED about behavioral health and facilitates educational programs to meet these needs.

NON-ESSENTIAL FUNCTIONS

Performs related and miscellaneous duties as assigned.

Why Mount Nittany Health?

At Mount Nittany Health, we provide high-quality patient care with a unique combination of the latest in clinical technology and compassionate medical professionals. We are committed to improving both the quality and availability of healthcare in our region and seek to hire only the best to support the communities we serve.