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.
- Nurse Manager Leadership Recommendations for Staff Engagement and Success - January 2, 2018
Our Visitors Found These Nursing Topics Useful
With so many specialties in nursing, it can be difficult to decide which specialty is the right fit. Nursing school provides several, but still limited, experiences. Some nurses are fortunate enough to find a role they love through those clinical…
Boards of Nursing are challenged to protect the health and welfare of the public by assuring that only competent and safe nursing care is being provided by licensed nurses of high moral character. Moral character can be assessed through a…
While it is true that most Americans (96%) own a mobile phone, the prevalence of smartphones has risen dramatically over the past 10 years to over 81%, according to surveys by Pew Research Center. That said, nurses are not immune…
We all know that sexism, gender stereotypes, and prejudice have hurt different groups throughout history, particularly women. It kept women from voting until the early 1900's... because surely a woman can't have an opinion about politics!. It kept many women…
When Senator Maureen Walsh made a flippant remark this week about nurses playing cards during their shifts, nurses across the globe went crazy. But for those who actually reviewed the footage of the now-sorry senator from Washington state, the request…