What is the Role of a Nurse Case Manager in an Emergency Room?
An emergency room is a fast-paced environment that includes a variety of staff including doctors, nurses, nursing assistants, registration/front desk, environmental service workers, laboratory staff, nurse practitioners, physician assistants and in some hospitals, even a case manager.
A case manager in the emergency room is most commonly filled by a registered nurse due to their clinical experience. The essential job functions of the nurse case manager are to manage patients to the appropriate level of care (which may or may not include hospitalization), ensure optimum utilization of resources to promote cost-effectiveness, safe discharge planning, and the overall improvement of patient satisfaction in a timely manner. It is important to note that not all ERs require case managers due to their patient population.
Depending on the position, a case manager may be asked to complete Utilization Review (UR). UR is the process of reviews and audits that ensure patients do not receive any unnecessary care to increase the cost of their healthcare. Most commonly, this process is performed by submitting reviews to insurance companies to ensure proper coverage of services.
Emergency room case managers have a unique role in that not all patients who enter the ER meet inpatient criteria for admission, but may require additional services for a discharge.
Some examples of things an ER case manager may be tasked with are as follows:
- Assist in placing the patient in a skilled nursing facility for short-term rehabilitation (PT/OT) and obtain authorization from insurance to provide coverage
- Assist in arranging home health services (PT/OT/RN) and obtain authorization from insurance to provide coverage
- Assist in obtaining Durable Medical Equipment (DME) such as a wheelchair for a patient and obtain authorization from insurance to provide coverage
- Assist in getting a patient set up on hospice services from the ER
- Assist in making a follow-up appointment to ensure the patient is seen in a timely manner
- Assist patient in linking to outpatient case management services
Case managers that work with uninsured or underinsured patient populations may face challenges as barriers to a safe discharge may present. In these cases, case managers may request the assistance of social workers to provide access to the appropriate resources for the patient.