Care Manager - Emergency Room
Company: Martin Luther King, Jr. Community Hospital
Posted on: June 25, 2022
Please apply online and send your resume to
Reporting to the Director of Care Management, the Care Manager is
responsible for managing the continuum of care from admission
through discharge for assigned patients. The role reflects
appropriate knowledge of RN scope of practice, current state
requirements, CMS Conditions of Participation, EMTALA, The Patient
Bill of Rights, AB1203 and other Federal or State regulatory agency
requirements specific to Utilization Review and Discharge Planning.
The Care Manager partners with the medical staff, utilizes
scientific evidence for best practices, and relevant data to manage
the care of the patient over the continuum of care from pre
hospitalization through discharge. These activities include
admission, continued, extended and discharge reviews in all
reimbursement categories to determine medical necessity, assure
high quality of care and efficient utilization of available
healthcare resources, facilities and services. This position
requires the full understanding and active participation in
fulfilling the Mission of Martin Luther King, Jr. Community
Hospital. It is expected that the employee will demonstrate
behavior consistent with the Core Values. The employee shall
support Martin Luther King, Jr. Community Hospital's strategic plan
and the goals and direction of the quality and performance
improvement process activities.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Is a role model for the Hospital's Patient Satisfaction effort
when interacting with customers, subordinates and colleagues.
- Collaborates with the interdisciplinary team participants in
team rounds to: facilitate timely care; sssure quality of care
- hospital stay; and minimize adverse outcomes.
- Initiates appropriate referrals to the internal
- Communicates with Admitting or PFS regarding the needs of the
patient, payer and provider are supported within the limitations of
the existing individual benefit structure.
- Communicates relevant elements of the health plan
- Establishes a working diagnosis (DRG) on every patient at the
time of admission to estimate the target length of stay or identify
the date of discharge for planning and care coordination
- Communicates target LOS/estimated discharge readiness to
physician, patient, family, care team and payor.
- Documents all team, physician and patient/family communication
and concerns pertaining to coordination of care and services.
- Screens every patient to identify need for further assessment
of medical necessity or discharge planning (standard description of
which patients are seen). 11. Adheres to the Care Management
Department policies and procedures.
- Participates in the Quality and Performance Improvement Plan
for the Care Management Department.
- Considers the patient population served, age-specific criteria
and the Watson Model of Care in all patient/family care and
- Utilizes Milliman Care Guideline's best practices to determine
patient disposition. Collaborates with on site Hospitalists,
Intensivists, Laborists and Emergency Department physicians in this
- Bachelor of Science degree in nursing preferred
- Associates degree in nursing required
- Minimum of one (1) to three (3) years of hospital inpatient or
related experience required.
- Able to navigate and connect successfully with outside provider
networks (Health Plans, IPA's, and FQHC's).
- Current California Nursing license
- Certification in Case Management preferred.
C. Special Skills/Knowledge
- Bilingual language skills preferred (Spanish)
- Basic computer skills
- Current Basic Life Support (BLS) Required
Keywords: Martin Luther King, Jr. Community Hospital, San Clemente , Care Manager - Emergency Room, Executive , Alhambra, California
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