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CHRISTUS Health Physician Jobs

Social Worker Job In Longview, Texas

Emergency Department Care Manager - Case Management - Full Time

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Company: CHRISTUS Health Profession/Specialty: Social Worker Location: 700 East Marshall Avenue
Longview, Texas 75601
Type of Facility: Hospital
Job Description
Description

Summary:

The Emergency Department (ED) Care Manager is responsible for establishing, coordinating, and maintaining the process to increase patient throughput to the most appropriate level of care while facilitating interdisciplinary care across the continuum for the ED. The Care Manager collaborates with the patient and/or family, multidisciplinary team, physicians, community partners, and payers to ensure the patient’s progress and level of care are appropriately determined. The Care Manager has well developed knowledge and skill in patient status in the inpatient and outpatient settings and collaborates with other care managers, social workers, Patient Access, physicians, and administrative leadership in the ED to determine the appropriate level of care. The Care Manager also has a robust understanding of services and resources outside of the hospital that would be of benefit to the patient and initiates referrals as indicated. This work includes patient assessment and management, resource management, identifying patients appropriate for admission, observation or outpatient status, care facilitation, discharge planning with referrals to all levels of care, and other duties related to the defined population. 

Responsibilities:

  • Uses approved criteria to conduct patient assessment and admission clinical review to ensure appropriateness of setting and timely implementation of the plan of care.
  • Performs review of anticipated admissions, placements in Observation status and discharges using evidence-based criteria set for appropriate level of care assignment.
  • Provides identification of patients for whom standard of care treatments could be safely rendered at home.
  • Screens appropriateness of admission including observation versus inpatient status.
  • Educates ED physicians and nurses about medical necessity and admission criteria.
  • Collaborates with physicians and other members of the treatment team on documentation needs and opportunities.
  • Utilizes high risk screening criteria to make appropriate community and post-ED referrals.
  • Initiates prior authorization process when indicated for post-ED referrals and services.
  • Escalates to physician advisor when unable to resolve discrepancies with the attending physician.
  • Manages high-use patients and works to find alternatives for care to frequent ED visits.
  • Plans for discharges from the ED for patients who do not require admission to include arranging for Home Health, DME, placement, and community resources as they relate to social determinants of health.
  • Provides patient and family education and counseling about existing health problem related care.
  • Anticipates barriers/variances to the delivery of care and intervenes as necessary.
  • Intervenes with physicians and ancillary departments concerning clinical and utilization issues to ensure optimal patient outcomes.
  • Coordinates and facilitates patient progression throughout the continuum.
  • Collaborates with all members of the interdisciplinary team to facilitate appropriate care coordination and care delivery.

Requirements:

Education/Skills

  • Associate's Degree in Nursing required
  • Bachelor’s Degree in nursing or healthcare related field preferred
  • Familiarity with evidence-based criteria sets
  • Demonstrate proficiency in computer skills - Windows, Instant Messaging, Microsoft Suite including Word, Excel, and Outlook
  • Competent in prior authorization functions including application of criteria and timelines.
  • Ability to analyze clinical information and accurately apply clinical criteria.
  • Proficient in medical and managed care terminology.
  • Knowledge of and competence in use of prior authorization software.
  • Ability to multitask between computer, fax, and multi-line phone requests.

Experience

  • 3+ years of relevant clinical case/care management experience in the acute care setting required

Licenses, Registrations, or Certifications

  • RN License in state of employment or compact
  • Case Manager certification preferred

Work Type:

Full Time


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Job Map - 700 East Marshall Avenue Longview, Texas 75601 United States
CHRISTUS Health Physician Jobs
About CHRISTUS Health

CHRISTUS Health is an international Catholic, faith-based, not-for-profit health system comprised of more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures.

Sponsored by the Sisters of Charity of the Incarnate Word in Houston and San Antonio and the Sisters of the Holy Family of Nazareth, the mission of CHRISTUS Health is to extend the healing ministry of Jesus Christ.

To support our healthcare ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on staff who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.

EXTENDING THE HEALING MINISTRY OF JESUS CHRIST

We are inspired by our mission, vision and core values to deliver compassionate, high quality health care, improving the health of the communities we serve. Above all, we are committed to providing our customers and their family members with a truly unique healing experience, one that embodies our values and respects the dignity and worth of each person. Creating a health care system that is truly excellent in all areas is an ongoing effort.

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