ED Care Manager

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking an ED Care Manager. 

Primary Responsibilities: 

• Develop individualized and targeted interventions to address members identified as ED high utilizers. 
• Research claims and authorization history to evaluate the member’s utilization patterns and drivers for frequent ED utilization. 
• Collaborate with hospital ED staff, PCP, home health agency, member, and CHNCT ICMs to facilitate immediate connections to care and services in the community, advocate for resources needed to meet members’ comprehensive health and psychosocial needs, and address gaps in care and barriers. 
• Address clinical and psychosocial needs that contribute to recurring ED visits and develop an individualized plan that may include referral to services, medication reconciliation, education and self-management coaching, and goals setting and planning.
• Partner with the care team to develop outpatient strategy for proper follow up care.

Tasks Performed: 

• Outreach to assigned members telephonically, via videoconferencing or onsite as indicated. 
• Conduct comprehensive assessment of member history and current presentation to identify needs and develop multidisciplinary interventions. 
• Explore and coordinate appropriate alternatives to ED care and communicate recommendations to attending physician, member/authorized representatives, and hospital care coordinator to facilitate appropriate and timely action. 
• Discuss anticipated plans with the inpatient providers/PCP, ICM and outpatient providers following initial ED contact. Initiate referrals as necessary. 
• Identify and refer Quality of Care (QOC) issues to the Quality Management department.
• Perform other duties as assigned.

Essential Functions: 

• Develops and maintains collaborative relationships with internal constituents and hospitals/providers. 
• Successfully interacts with business partners. 
• Utilizes referral criteria for triage of members to appropriate CHNCT departments.
• Collaborates to review members with potential ED over utilization risks (i.e., multiple co-morbid conditions, pain management, behavioral health issues, alcohol/substance abuse, and chronic pain) and works with the care team to formulate plans to address.
• Maintains knowledge of CHNCT programs, other ASO and community programs, vendors, and covered benefits for the Medicaid programs.

Desired Education: Two to four years post-secondary schooling

Desired Degree: Associate's degree, Bachelor's degree preferred

Desired Major: Nursing (required)

Desired Job Experience: Minimum two years direct clinical care experience as an RN is required.

Other Qualifications: Strong verbal and written communication skills. Excellent organizational skills, ability to manage multiple priorities concurrently. Demonstrates strong critical thinking and problem-solving skills. Ability to work independently and in a team environment. Uses tact and diplomacy for highly sensitive information and issues. Team player. Strong computer and keyboard skills. Flexible in covering assignments. Case Management experience preferred. Knowledge of Medicaid regulations preferred. RN license must be current and unrestricted.

Certifications Required: Active Registered Nurse License

CHNCT Offers Great Benefits:

• Medical, dental and vision coverage options
• Flexible spending and health savings accounts
• Group term life insurance
• A 401(k) plan with company-match and immediate vesting
• Voluntary accidental injury coverage
• Tuition reimbursement and continuing education opportunities
• A generous paid-leave bank and company holidays
• Wellness program