ED Case Manager (RN) Care Management FT Days
Work Hours/Shifts Days / 3 x 12hr
Days / 3 x 12hr
Shawnee Mission Health
SMH has provided faith-based, whole person care to the Kansas City community since 1962. SMH is more than just a hospital campus. We’re a network of health care facilities working to exceed expectations by delivering quality care with compassion and supporting an exceptional staff of more than 700 physicians representing 50 medical specialties.
Our mission of Improving Health Through Christian Service is achieved each and every day through the dedication and commitment of our associates, physicians and volunteers. We strive to be a regional beacon of wellness, hope and healing attracting customers seeking unsurpassed clinical quality and compassionate care for the whole person, following the example of Christ's healing ministry.
The largest health care provider in Johnson County, Kansas, the SMH network includes SMMC and SMH - Prairie Star and SMH - Overland Park, a third major health care facility. Our 54-acre campus at SMMC is comprised of the main hospital, a community health education building, six physician office buildings and an associate child care center. The Emergency Department at SMMC is the busiest in Johnson County. We deliver more babies each year at the Shawnee Mission Birth Center than any other hospital in the metropolitan area and our Center for Women’s Health is nationally recognized. We have seven Shawnee Mission Primary Care locations with more than 30 Board-certified doctors who specialize in family medicine, internal medicine and pediatrics as well as Centra Care Shawnee Mission Urgent Care locations.Qualifications
- Coordinates the integration of utilization management, care coordination and discharge planning for patient care to meet established level of care standards and cost per case requirements; all while meeting patient needs.
- Conducts initial level of care reviews on patients presenting in the Emergency Room for possible hospitalization to ensure appropriateness of the setting and timely implementation of the clinical plan.
- Coordinates initial plan of care and level of service with Emergency Room/Attending physician at time of transition from the Emergency Department to the acute setting to ensure that the Attending/Admitting physician has sufficient information to justify the level of care chosen.
- Provides recommendations for transition to the hospital setting and movement of patients efficiently through the system. Facilitates coordination of services as indicated by review.
- Collaborates with the physician and the care team to ensure appropriateness of initial clinical documentation corresponding with the patient’s care need at time of initial hospitalization.
- Communicates effectively with third party payers regarding certification, completing initial review prior to or at time of admission.
- Mobilizes resources to achieve expected goals per the patient’s plan of care and ensures that patient diagnostics are appropriate and necessary and completed with the established timeframe.
- Consults the Social Worker as appropriate for patients requiring crisis intervention, psychosocial and substance abuse services, protective services per established protocol.
- Manages short term social interventions to assist in avoiding unnecessary admission such as referral to home health, homeless shelters, domestic violence programs, etc.
- Completes timely and appropriate documentation in all Case Management systems regarding assessments, interventions, reviews, e.g., return admissions, avoidable days.
- Consults the physician advisement process as necessary to resolve issues per established protocol.
- Communicates with the inpatient Case Managers or Social Workers any high risk issues or concerns.
- Effectively delegates case management tasks to Case Management Assistants related as appropriate per scope
- Reports and documents adverse events and reportable conditions.
- Assesses appropriate level of service of assigned patients and makes indicated documentation.
- Maintains knowledge of and application of evidence based and medical necessity criteria.
- Demonstrates knowledge and use of regulatory guidelines and requirements for utilization management as indicated by JTC, CMS, KFMC and other agencies as appropriate.
- Demonstrate proficiency in use of the electronic medical record and programs specific to the role
- Incorporates patient, physician, customer needs and concerns into decision-making and organizational action.
- Evaluates patient satisfaction and intervenes/acquires resources to insure patient and family needs are met.
- Serves as patient advocate and enhances a collaborative relationship between the physician and multidisciplinary team with the patient and family to maximize informed decisions.
- Anticipates the needs of external reviewers. Attempts to address those needs prior to calling reviewers.
- Incorporate findings from daily review processes to provide global view and perspective to organizational efforts which addresses utilization management issues.
- Contribute to development of competencies related to job function and participate in competency evaluations.
- Participate in Performance Improvement activities.
- Inform Patient Financial Services of patients needing financial counseling.
- Tracks and document readmission information with proactive concurrent action taken when indicated.
- Completes additional initial utilization management reviews after patients have been placed in a bed as time allows.
- Cross-trains with Access Case Management for assisting with coverage in that area
- Cooperate with changes in staffing schedules and workload in order to achieve department productivity standard.
- Provides conscientious commitment to assigned work, work schedule, honesty, teamwork, assisting others to bring about positive outcomes.
- Recognizes and manages risks, resolves issues and problems as soon as they arise, reports and documents adverse events and reportable conditions.
- Verbally and behaviorally supports Shawnee Mission Health’s mission and values. Develop a helpful attitude and purpose towards customers,
- Documents appropriately and timely in Case Management department computerized system.
- Participates in department and organizational meetings.
- Assists in training of new hires.
- Associate’s Degree in Nursing
- 2 Years minimum of Position-Related Experience in an Acute Medical Hospital setting within the last 3 years OR 2 years minimum of Care Management Experience in an insurance company setting
- Kansas Registered Nurse License
- Bachelor’s Degree in Nursing Preferred
- 2 to 5 Years of Position-Related Experience Preferred
- Knowledge and Application of Evidence Based Criteria Preferred
- Knowledge and Application of Regulatory Agency Requirements Preferred
- Certified Case Manager (ACMA or CMA) Preferred