Job Description

For more than a century, Salt Lake Regional Medical Center has provided has provided high-quality healthcare for residents of the Salt Lake Valley. Conveniently located near the heart of the city, this historic hospital remains one of the most trusted medical centers in all of Utah. Today’ you’ll find the most advanced medical technology in a world-class facility, a staff committed to staying on the leading edge of healthcare and patients who still find the kind of comfort and caring for which Salt Lake Regional always has been known.

Some areas of expertise include: Emergency Medicine, Heart Care, Cancer Care, Women’s Health, Men’s Health, Diagnostic Imaging, Surgical Services, and Behavioral Health among others.

Case Manager- Emergency Department

 
The Emergency Department Case Manager assumes primary responsibility for documentation of appropriate medical necessity for inpatient status or placement in observation. Communicates with physician, ancillary staff, and payers, and assists in arranging transfers or alternate placement when indicated. Assures proper level of care assignment. Collaborates and coordinates with other allied health professionals in the ED to ensure quality care is provided and desired outcomes are achieved, in a timely and cost-effective manner. Utilizes a complete and systematic methodology/process to assess, plan, implement, evaluate and provide patient care coordination from pre-hospital through ED discharge. Assists in the development of physician profiles to identify over/under utilization patterns. Promotes appropriate post-hospital utilization of resources. Ensures  adequate education of patient and ED/hospital staff. Works to reduce incidents of re-admissions. Supports hospital goals and objectives. Works within regulatory compliance guidelines. The ED Case Manager works collaboratively with all healthcare disciplines to assure appropriate and timely services.  Assesses the medical appropriateness, quality, and cost-effectiveness of proposed hospital, medical, and surgical services. Collaborates with the interdisciplinary team to assist patient with benefits management. Evaluates appropriateness of the level of care.  Communicates with payers to obtain authorization. Identifies and plans strategies to reduce the length of time for ED Extended length of stay and resource utilization.



Qualifications

Requirements:

  • Minimum Education: Associate Degree or Two year technical program in Nursing.
  • Current State RN license in good standing.
  • One - three years experience involving case management/utilization review responsibility in an acute care hospital and/or managed care setting is preferred.
  • Must possess a  thorough working knowledge of Medicare, Medicaid and managed care utilization review requirements
  • Must be familiar with federal, state and accreditation standards as they relate to case management and utilization review.
  • Able to communicate effectively with staff, physicians, patients and families.
  • Able to work independently, be flexible with many interruptions & think critically.

Skill Set:

 

Ability to work competently with computer based charting and other clinical and non-clinical software programs. Adaptability to change and good organizational skills required. May give presentations as directed. Working knowledge of criteria for Medicare, Medicaid, HMO, and private insurance carriers coverage details. Ability to advocate for patients. Ability to operate office equipment. Possess critical thinking skills. Leadership skills required for role include effective mentoring, coaching, counseling, time management, problem solving, and strategic planning. Demonstrates initiative and pro-active approach to problem resolution. Ability to effectively interact with insurance companies and community healthcare resources. Ability to work in a stressful, fast paced environment. Must master Microsoft Office Products, i.e. Excel, Word etc. Understands CMI, patient status, InterQual Criteria, Milliman Criteria, and Transfer DRG’s.

Steward Health Care is an equal opportunity employer Minority/Female/Disabled/Veteran

"Salt Lake Regional Medical Center is directly or indirectly owned by an entity that proudly includes physician owners, including certain members of the hospital's medical staff."

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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