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CentraState Healthcare System

Not-for-profit health system delivering comprehensive care

Emergency Department Registered Nurse - RN, Care Manager

Medical, Clinical & VeterinaryUpdated on Nov 14
Full-timeFreehold Township, NJ, USA$93.6k - $159.1k /yrIn-person

About the Job

Requirements

  • An Associate’s degree in Nursing is required.
  • A Bachelor’s degree in Nursing is required within three years of hire.
  • Prior clinical experience in the care and management of hospitalized patients is required.
  • A New Jersey registered nurse license is required.
  • Excellent communication, negotiation, and conflict resolution skills are required.
  • Data and computer skills are required.
  • Knowledge of relevant state utilization review and appeals requirements is required.
  • Rapid-cycle change or clinical performance improvement expertise is required.

Responsibilities

  • Complete initial medical necessity reviews on emergency department patients with potential for admission and work with providers to identify the appropriate level-of-care designation; document according to established policy and procedure and educate emergency department physicians and nurses about medical necessity and admission criteria.
  • Use social work screening criteria to make appropriate referrals for high-risk patients and identify patients or families with complex psychosocial needs, ongoing medical discharge-planning issues, or continuing-care needs for referral to a social worker.
  • Collaborate with medical staff to recommend referrals for outpatient care, home health, or other community agencies as indicated; provide post-discharge follow-up by conducting or delegating telephone evaluations of discharge plans; and work with the team to establish interventions for high utilizers.
  • Expedite diagnostic tests needed to determine patient disposition, offer alternatives to admission when appropriate, and participate in boarder rounds to determine whether disposition changes are needed.
  • Initiate discharge planning by screening for social determinants of health and conducting initial discharge-planning assessments for patients admitted through the emergency department.
  • Maintain knowledge of federal, state, and other regulatory agency rules and regulations, including The Joint Commission, CMS, and Medicare requirements, including CMS rules regarding observation status, the 2 Midnight Rule, and Medicare Inpatient Only Procedures.
  • Maintain knowledge of continuum-of-care resources and provide education and resources to patients, families, and the health care team on effective progression of care, utilization of services, appropriate level of care, and safe patient transitions.
  • Identify potential risk-management or quality issues and work with the health care team to resolve them or refer them through the chain of command to the appropriate resource or committee.
  • Perform other duties as assigned by management.

Desired Qualifications

  • Experience in acute-care utilization is preferred.
  • Utilization review or case-management training from a professional case-management organization is preferred.
  • Case-management certification is preferred.

About the Company

CentraState Healthcare System

Not-for-profit health system delivering comprehensive care

CentraState Healthcare System is a private, not-for-profit health organization that delivers a full range of health and wellness services through its teaching hospital network. Care is provided by a coordinated system of clinicians, educators, and nurses, with medical residents and Magnet-designated nursing staff contributing to patient care. It differentiates itself by combining community health services with medical education, maintaining not-for-profit status, and earning Magnet status for nursing excellence. Its goal is to provide accessible, high-quality health care while training future doctors and nurses and improving the health of the community.

Company size
1,001-5,000
Company stage
Not listed
Total funding
Not listed
Headquarters
Freehold Township, NJ
Founded
1971

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