Exemption Status: Non-Exempt
Schedule Details: Sunday through Saturday, Weekends - Every Third Weekend
Scheduled Hours: 9AM-9:30PM
Shift: 1 - Day Shift, 12 Hours (United States of America)
Hours: 0
Cost Center: 26000 - 4402 Case Management
This position may have a signing bonus available, and a member of the Recruitment Team will confirm eligibility during the interview process.
At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence, and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve.
In collaboration with other members of the healthcare team, the Point of Entry/Emergency Department Case Manager (POE/ED CM) is accountable for coordination and facilitation of the management of care for ED patients, both inpatient and observation.
Major Responsibilities: Patient Identification and Communication: Reviews all ED patients promptly, reviews all admitted patients within one hour of admission or before admitting orders are placed, intervenes early for patients with progressive conditions or complex needs, and ensures communication among MSW, CM, and ED care team.
Assessment and Documentation: Completes and documents initial discharge planning assessments, refers complex or high-utilizer patients for MSW psychosocial assessment, and identifies and documents readmissions for follow-up.
Utilization Review: Completes admission reviews using InterQual criteria, collaborates with providers to resolve discrepancies in medical necessity, and documents clinical reviews in Meditech per standards.
Discharge and Transition Planning: Executes discharge plans in collaboration with ED and admitting physicians, prioritizes discharges requiring post-acute care arrangements, and arranges services such as Home Health, DME, SNF, rehab, and medications.
Escalation and Issue Resolution: Escalates unresolved cases to appropriate leadership, follows formal escalation processes for utilization and level of care issues, and documents avoidable delays for boarded ED patients daily.
Age-Specific Competency: Applies knowledge of growth and development stages to patient care and demonstrates age-appropriate communication and support.
Position Qualifications: License/Certification/Education: Required: Bachelor of Science in Nursing, Current Massachusetts RN license. Preferred: CCM certification.
Experience/Skills: Required: Minimum 3 years of medical, surgical, ICU, or ED nursing experience, demonstrated sound judgment and knowledge of medical care and support services, excellent interpersonal and communication skills, analytical ability to evaluate patient care needs and service appropriateness. Preferred: 3-5 years of hospital-based case management, Emergency department experience, Utilization review experience.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.
If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org.