RN, Care Manager, Emergency Department

Adventist Health • Full-time • Simi Valley, CA, US • $54 - $74 / hour • 1w ago

Centered in beautiful Southern California, Adventist Health Simi Valley has been one of the area's leading healthcare providers since 1965. We are comprised of a 144-bed hospital, home care services and a vast scope of award-winning services located throughout Ventura County. Simi Valley is a suburban area nestled between an urban oasis and the stunning shores of the Pacific Ocean. Bordering Los Angeles allows hiking in the morning and attending film premieres in the evening.

Job Summary:

Establishes, coordinates, and maintains the process to increase patient through-put to the most appropriate level of care while facilitating interdisciplinary care across the continuum for the Emergency Department (ED). Collaborates with the patient/family, multidisciplinary team, physicians, community resources and payers to ensure the patient’s progress and level of care is appropriately determined for the emergency episode of care and for the inpatient encounter to ensure that care is performed and facilitated in an efficient and cost-effective manner. Uses well developed knowledge and skills in patient status determination (InterQual Criteria), in the assessment and care management of patients and families within the ED, inpatient and outpatient settings. Practices patient/family assessment and management, resource management, identifying patients appropriate for inpatient admission, observation, or outpatient status, care facilitation, discharge planning with referral to all levels of care, and other related duties specific to the defined patient population. Collaborates with other case managers, social work staff, the access center, admissions, and other physician and administrative leadership staff within the ED, the care management department and both the inpatient and outpatient settings. Uses knowledge of pathophysiology, pharmacology, and clinical care processes to participate with other clinical staff and physicians in the development of clinical practice guidelines and physician order sets for the purpose of improving quality of care, changing practice, and reducing costs.

Job Requirements:

Education and Work Experience:

Bachelor's Degree in Nursing (BSN): Preferred
Master's Degree in nursing or health care related field: Preferred
Experience in case management, utilization management, and/or transitional care: Preferred

Licenses/Certifications:

Registered Nurse (RN) licensure in the state of practice: Required
Accredited Case Manager, Certified Case Manager, or Board Certification in Case Management: Preferred

Essential Functions:

Acts as a resource to ED staff and physicians regarding appropriateness of admission, levels of care (including related documentation requirements and observation vs. inpatient requirements), quality of care concerns and criteria/guidelines/protocols utilized in care planning and resource utilization.
Gathers sufficient information from and communicates with all relevant sources to facilitate appropriate discharge from ED to appropriate level of care to assure it is done in an accurate, safe, timely and cost-effective manner to prevent readmission and/or frequent visits to ED.
Assists in triaging calls from other acute care facilities requesting patient transfers to EMC; determines transfer appropriateness by reviewing requested documentation and InterQual level of care criteria and discussions as necessary with admitting physician, supervisors and/or EMC administrators and/or other EMC personnel.
Assesses ED patients and identifies options other than acute hospital admission when appropriate. Screens and refers to acute rehabilitation, long-term acute care hospitals, and nursing homes for admission directly from the ED; screens and refers patients to clinics after initial exam; and screens and refers patients for whom treatments could be safely rendered at home with services (e.g., IV antibiotics, low molecular weight heparin injections, wound care, etc.).
Organizes, integrates, and evaluates the effectiveness of the plan of care and progress toward achievement of desired outcomes. Modifies plan of care as patient/family needs change to accomplish goals established in the plan of care. Communicates plan of care, including changes and issues related to plan of care to patient/family, physicians, and other members of the healthcare team.
Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.

ABOUT US

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 90 communities on the West Coast and Hawaii with over 400 sites of care, including 26 acute care facilities, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of 37,000 includes employees, physicians and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

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