Wesley Long ED - Emergency Department Care Coordinator

Company: Cone Health
Location: Greensboro
Posted on: November 26, 2022

Job Description:

The ED Patient Intake Coordinator is responsible for facilitating the patient?s hospitalization from preadmission through discharge from the Emergency Department to the community or to an alternative level of care. The Coordinator interfaces with physicians, nurses, social workers (Care Management Department), and other healthcare team members to expedite medically appropriate cost-effective care. The Coordinator applies clinical expertise and medical appropriateness criteria to resource utilization, admissions and discharge planning.The Coordinator evaluates the medical necessity for admission, and appropriateness of patient care unit placement for all ED hospitalized admissions when on duty and provides consultation to physicians prior to patient placement. Upon discharge of the patient from the ED, will coordinate clinical and financial discharge planning needs as necessary so that a smooth transition from the acute outpatient care setting to the community setting is ensured and inappropriate readmission is averted. The Coordinator refers to Care Management Department patients with complex psychosocial or discharge planning needs and follows-up to ensure appropriate intervention. Dialogues with the payers as necessary to guarantee appropriate reimbursement. Communicates with physicians and other members of the interdisciplinary healthcare team to ensure appropriate utilization of resource and implementation of clinical practice guidelines or standing orders to meet expected standards of care for patients in the ED. Provides support and information to patients/families with identified financial or psychosocial needs. Serves as the liaison for the other members of the interdisciplinary team to ensure appropriate and expedient referrals upon decision to admit to the acute care inpatient setting.**Position may be non-exempt depending upon schedule (e.g., Weekend).Initial Patient Screening: Identifies high risk patients (via identified criteria) through rounding and referrals from ED physicians, nurses, hospitalists, primary care physicians (PCP), ED patients and families for high risk patients. Uses ED tracking system, medical record, and demographic information to identify patients needing CM intervention. Identify patients with frequent ED visits. Identify patient returning in 48 hours to ED.Utilization Review: Screens all ED patients who are to be admitted to determine payer source prior to physician admit orders. Works with physicians to ensure admission to the appropriate status, using UR Committee approved criteria and hospital policies. Educates physicians and staff to understand admission status and appropriate patient placement and other regulatory requirements. Ensures accurate insurance information and initiates the UR process for commercial payors as able per organization policy. Escalates to physician advisor when unable to resolve issues with the attending physician, according to policy and timeframes established. Issues preadmission hospital issued notice of non coverage (HINN) for Medicare patients per physician advisor determination and Medicare guidelines, when medical necessity criteria are not met. Acts as resource to ED staff for issues related to utilization review processes for emergency admissions. Acts as resource to the ED staff for regulatory issues regarding the discharge-planning process from the ED."Evidence Based Care: Collaborates with other members of the interdisciplinary team to ensure ED relevant evidence based standards of care are met.Follow Up: Follow up as needed with high-risk patients via phone to ensure establishment with PCP, access, prescriptions, payer sources, self-management, etc. Create CM plans for patients with chronic diseases using the ED often.Documentation: Employers a high degree of skill in all verbal and written communications and personal interactions and demonstrates collaborative working relationships. Meets assigned deadlines and qualify standards without reminder from supervisor or others. Completes required departmental documentation to comply with state and federal regulations in a timely manner. Documents according to policy."Discharge Planning & Placement: Identifies and ensures a safe discharge for high risk patients who are discharged from the ED. Ensures that any information that would be helpful, as appropriate, to facilitate continuity of care post-discharge, are communicated to post-acute provider via discharge paperwork in CAS or via phone as per departmental documentation guidelines. Assess ED patients and identify options other than acute hospital admission when appropriate:Regulatory Compliance: Maintains clinical competency and current knowledge of regulatory and payer requirements to perform job responsibilities. Comply with all applicable state and federal regulations as well as The Joint Commission requirements regarding the CM process.Care Coordination and Patient Flow: Initiates the Care Coordination Assessment for patients who will be admitted. Interview patients/family/significant others, as clinically appropriate, to gather relevant baseline data, identify their understanding and expectations of treatment plan and identify any potential issues/barriers to arranging post-acute care. Integrate an awareness of cultural factors in the patient/family interview process and elicit clinically relevant cultural information. Facilitates communication and translation of above stated information to inpatient Care Coordinators for patients who will be admitted to inpatient or observation. Facilitates the initiation of diagnostic services, treatment planning, and therapeutic treatment while patient is present in the emergency department for patients to be admitted. Review all available assessment and treatment planning data provided by other members of the interdisciplinary team. Reinforces patient education while the patient is in the ED. Coordinates family involvement and decision making as needed. Coordinates the process of admission with the ED Nurse to ensure efficient patient flow. Assists in securing and transferring patients to an inpatient bed in a timely manner. Actively participates in the daily bed huddle and serves as an advocate of effective and courteous interdepartmental communication to facilitate house-wide movement of patients. Facilitates referrals and consults from other physicians and members of the interdisciplinary team, as appropriate. Ensures timely intervention by the admitting physician. Consults with admitting office and patient financial services to initiate Medicaid and indigent care applications. Documents according to policy.EDUCATION:Bachelors, Nursing, PreferredCurrent license to practice as a Registered Nurse in the State of North CarolinaEXPERIENCE:3 to 5 Years, Clinical Experience Required as RN in a hospital, preferably some ED experiencePrevious, Experience preferred in utilization review and discharge planningAt least 3-5 years of clinical experience as a registered nurse in a hospital, preferably at least some ED experience. Leadership experience preferred. Utilization review and discharge planning experience preferred.LICENSURE/CERTIFICATION/REGISTRY/LISTING:REQUIREDRN - Registered Nurse licensed in North Carolina or a Compact state.Experience and certification with InterQual.PREFERREDRequisition ID (iCIMS): 2022-12449 Name: Wesley Long Hospital Name: WLCH-Emergency Requisition Sub Category: RN - EMERGENCY DEPT Relationship to Org: Employee Exempt/NonExempt: Non-Exempt External Company Name: Cone Health Street: 2400 W Friendly Ave FTE: 1.00 Work Hours: 40.00 Provider Schedule (specific schedule): 1:00 PM - 9:00 PM Position Sub Category: RN - Emergency Department

Keywords: Cone Health, Greensboro , Wesley Long ED - Emergency Department Care Coordinator, Other , Greensboro, North Carolina