The Emergency Department (ED) Care Manager is responsible for establishing, coordinating, and maintaining the process to increase patient throughput to the most appropriate level of care while facilitating interdisciplinary care across the continuum for the ED.
Posted Oct 6 · 3 years of experience
Shift and hours
5 Days - 8 Hours · 8 Hours Work Schedule: 5 Days - 8 Hours5 shifts · 40 hours a week
Unit and setting
Emergency Department · Hospital
License
RN license RN or LMSW in the state of employment is required
Term
Permanent Work Type: Full TimeFull Time
Do you qualify?
License
RN or LMSW in the state of employmentRN or LMSW in the state of employment is required
Education
Graduate of an accredited school of nursing or Master's degree in Social Work (MSW)Graduate of an accredited school of nursing (BSN preferred) or Master’s degree in Social Work (MSW) required
Experience
3+ years of relevant clinical case/care management experience in the acute care setting3+ years of relevant clinical case/care management experience in the acute care setting required
Also asks
Familiarity with evidence-based medical necessity criteria setsFamiliarity with evidence-based medical necessity criteria sets required
Also asks
Competency in prior authorization functions and software, including application of criteria and timelinesCompetency in prior authorization functions and software, including the application of criteria and timelines required
Also asks
Proficiency in medical and managed care terminologyProficiency in medical and managed care terminology required
Preferred
Certification
Case Manager certificationCase Manager certification preferred
Initiate external referrals and services for patient benefitThe Care Manager also has a robust understanding of services and resources outside of the hospital that would be of benefit to the patient and initiates referrals as indicated.
Day to day
Patient assessment, resource management, admission identification, and discharge planning
Day to day
Meet OneCHRISTUS CompetenciesMeets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
Day to day
Conduct patient assessment and admission clinical review using approved criteriaUses approved criteria to conduct patient assessment and admission clinical review to ensure the appropriateness of setting and timely implementation of the plan of care.
Day to day
Review anticipated admissions, observation placements, and dischargesPerforms review of anticipated admissions, placements in Observation status, and discharges using evidence-based criteria set for appropriate level of care assignment.
Day to day
Identify patients for safe home care treatmentsProvides identification of patients for whom standard of care treatments could be safely rendered at home.
Day to day
Screen appropriateness of admission including observation versus inpatient statusScreens appropriateness of admission including observation versus inpatient status.
Day to day
Educate ED physicians and nurses regarding medical necessity and admission criteriaEducates ED physicians and nurses about medical necessity and admission criteria.
Day to day
Collaborate with physicians and treatment team on documentation needsCollaborates with physicians and other members of the treatment team on documentation needs and opportunities.
Day to day
Utilize high-risk screening criteria for community and post-ED referralsUtilizes high-risk screening criteria to make appropriate community and post-ED referrals.
Day to day
Initiate prior authorization process for post-ED referrals and servicesInitiates prior authorization process when indicated for post-ED referrals and services.
Day to day
Escalate to physician advisor for unresolved discrepancies with attending physicianEscalates to physician advisor when unable to resolve discrepancies with the attending physician.
Day to day
Manage high-use patients to find alternatives to frequent ED visitsManages high-use patients and works to find alternatives for care to frequent ED visits.
Day to day
Plan ED discharges including arranging Home Health, DME, placement, and community resources
Day to day
Provide patient and family education and counselingProvides patient and family education and counseling about existing health problem-related care.
Day to day
Anticipate barriers and variances to care delivery and interveneAnticipates barriers/variances to the delivery of care and intervenes as necessary.
Day to day
Intervene with physicians and ancillary departments regarding clinical and utilization issuesIntervenes with physicians and ancillary departments concerning clinical and utilization issues to ensure optimal patient outcomes.
Day to day
Coordinate and facilitate patient progression throughout continuumCoordinates and facilitates patient progression throughout the continuum.
Day to day
Collaborate with interdisciplinary team on care coordination and deliveryCollaborates with all members of the interdisciplinary team to facilitate appropriate care coordination and care delivery.
Day to day
Analyze clinical information and apply clinical criteriaAble to analyze clinical information and accurately apply clinical criteria.
The Emergency Department (ED) Care Manager is responsible for establishing, coordinating, and maintaining the process to increase patient throughput to the most appropriate level of care while facilitating interdisciplinary care across the continuum for the ED. The Care Manager collaborates with the patient and/or family, multidisciplinary team, physicians, community partners, and payers to ensure the patient’s progress and level of care are appropriately determined. The Care Manager has well-developed knowledge and skill in patient status in the inpatient and outpatient settings and collaborates with other care managers, social workers, Patient Access, physicians, and administrative leadership in the ED to determine the appropriate level of care.
The Care Manager also has a robust understanding of services and resources outside of the hospital that would be of benefit to the patient and initiates referrals as indicated. This work includes patient assessment and management, resource management, identifying patients appropriate for admission, observation or outpatient status, care facilitation, discharge planning with referrals to all levels of care, and other duties related to the defined population.
Responsibilities
Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
Uses approved criteria to conduct patient assessment and admission clinical review to ensure the appropriateness of setting and timely implementation of the plan of care.
Performs review of anticipated admissions, placements in Observation status, and discharges using evidence-based criteria set for appropriate level of care assignment.
Provides identification of patients for whom standard of care treatments could be safely rendered at home.
Screens appropriateness of admission including observation versus inpatient status.
Educates ED physicians and nurses about medical necessity and admission criteria.
Collaborates with physicians and other members of the treatment team on documentation needs and opportunities.
Utilizes high-risk screening criteria to make appropriate community and post-ED referrals.
Initiates prior authorization process when indicated for post-ED referrals and services.
Escalates to physician advisor when unable to resolve discrepancies with the attending physician.
Manages high-use patients and works to find alternatives for care to frequent ED visits.
Plans for discharges from the ED for patients who do not require admission to include arranging for Home Health, DME, placement, and community resources as they relate to social determinants of health.
Provides patient and family education and counseling about existing health problem-related care.
Anticipates barriers/variances to the delivery of care and intervenes as necessary.
Intervenes with physicians and ancillary departments concerning clinical and utilization issues to ensure optimal patient outcomes.
Coordinates and facilitates patient progression throughout the continuum.
Collaborates with all members of the interdisciplinary team to facilitate appropriate care coordination and care delivery.
Able to analyze clinical information and accurately apply clinical criteria.
Job
Requirements
Education/Skills
Graduate of an accredited school of nursing (BSN preferred) or Master’s degree in Social Work (MSW) required
Experience
3+ years of relevant clinical case/care management experience in the acute care setting required
Familiarity with evidence-based medical necessity criteria sets required
Competency in prior authorization functions and software, including the application of criteria and timelines required
Proficiency in medical and managed care terminology required
Neighborhoods+Nurses and young professionals typically land in Downtown San Marcos and The Square District for walkable restaurants and Texas State energy (homes roughly $250K–$450K, with tighter parking during the semester); Blanco Gardens, about a mile east of downtown between the Blanco and San Marcos rivers and right off I-35, for cheaper rents and a 5–10 minute drive to The Square; and master-planned Blanco Vista ($300K–$480K) or newer Cottonwood Creek ($280K–$420K) for community pools, trails, and an off-peak ~30-minute drive toward Austin or San Antonio. Facebook locals also name La Cima and Heritage. Rio Vista draws river-oriented renters; west of I-35 and Hunter’s Hill/River Road ($350K–$600K) are quieter, pricier Hill Country and river-acreage options. Kissing Tree ($300K–$500K) is a 55+ golf community south of town, not a typical nurse pocket.
Nurses and young professionals typically land in Downtown San Marcos and The Square District for walkable restaurants and Texas State energy (homes roughly $250K–$450K, with tighter parking during the semester); Blanco Gardens, about a mile east of downtown between the Blanco and San Marcos rivers and right off I-35, for cheaper rents and a 5–10 minute drive to The Square; and master-planned Blanco Vista ($300K–$480K) or newer Cottonwood Creek ($280K–$420K) for community pools, trails, and an off-peak ~30-minute drive toward Austin or San Antonio. Facebook locals also name La Cima and Heritage.
Rio Vista draws river-oriented renters; west of I-35 and Hunter’s Hill/River Road ($350K–$600K) are quieter, pricier Hill Country and river-acreage options. Kissing Tree ($300K–$500K) is a 55+ golf community south of town, not a typical nurse pocket.
Getting around+San Marcos sits on Interstate 35, about 30 miles south of Austin and roughly 45 minutes north of San Antonio; the typical local commute is about 24 minutes, but I-35 congests at peak hours and most neighborhoods are car-dependent. Blanco Vista is described as about 30 minutes off-peak to either metro; Kissing Tree about 35 minutes to Austin. Ascension Seton Hays is the primary hospital serving the area. Apartments cluster on I-35 frontage and the streets ringing Texas State; south I-35 rentals such as The Lanes at Oslo are a short drive to downtown, campus, and the outlet malls. Relocation guides urge touring during a Texas State semester to feel real traffic and parking pressure near campus.
San Marcos sits on Interstate 35, about 30 miles south of Austin and roughly 45 minutes north of San Antonio; the typical local commute is about 24 minutes, but I-35 congests at peak hours and most neighborhoods are car-dependent. Blanco Vista is described as about 30 minutes off-peak to either metro; Kissing Tree about 35 minutes to Austin.
Ascension Seton Hays is the primary hospital serving the area. Apartments cluster on I-35 frontage and the streets ringing Texas State; south I-35 rentals such as The Lanes at Oslo are a short drive to downtown, campus, and the outlet malls.
Relocation guides urge touring during a Texas State semester to feel real traffic and parking pressure near campus.
Outdoors+The spring-fed San Marcos River runs crystal-clear at about 72°F year-round through the middle of town and is the default recreation: tubing, kayaking, swimming, and fishing, with Rio Vista Park the easy picnic-and-put-in park. Purgatory Creek Natural Area covers more than 1,000 acres of trails next to La Cima (together among the largest urban natural areas in Texas); Spring Lake Natural Area and The Meadows Center offer headwaters walks and glass-bottom boat tours over the springs. Canyon Lake is less than 25 minutes from La Cima, with 80 miles of shoreline, 8,230 surface acres, and eight public parks for boating and fishing. Wonder World Cave & Adventure Park and Ringtail Ridge add caves and more trail miles.
The spring-fed San Marcos River runs crystal-clear at about 72°F year-round through the middle of town and is the default recreation: tubing, kayaking, swimming, and fishing, with Rio Vista Park the easy picnic-and-put-in park. Purgatory Creek Natural Area covers more than 1,000 acres of trails next to La Cima (together among the largest urban natural areas in Texas); Spring Lake Natural Area and The Meadows Center offer headwaters walks and glass-bottom boat tours over the springs.
Canyon Lake is less than 25 minutes from La Cima, with 80 miles of shoreline, 8,230 surface acres, and eight public parks for boating and fishing. Wonder World Cave & Adventure Park and Ringtail Ridge add caves and more trail miles.
Check the commute at your shift’s start and end, upfront housing costs, and whether moving assistance must be repaid if you leave.
Living in San Marcos
San Marcos is a spring-fed college town on I-35 between Austin and San Antonio, defined by a crystal-clear river that stays about 72°F year-round and a still-walkable, locally owned downtown. For a nurse, the practical appeal is cheaper housing than Austin, a ~24-minute typical local commute, and outdoor life you can actually use after a shift: tubing and swimming from Rio Vista Park, trails at 1,000-acre Purgatory Creek, glass-bottom boats at The Meadows Center, and Canyon Lake under 25 minutes out. Live near Downtown and The Square if you want restaurants and music in walking distance—and can tolerate semester crowds and tight parking. Choose Blanco Gardens for lower rent and I-35 access, or Blanco Vista and Cottonwood Creek (roughly the high $200Ks to $400Ks) for newer homes, pools, and a 30-minute off-peak shot at either metro. Ascension Seton Hays is the area’s primary hospital; most errands still require a car. Tradeoffs are honest: about 38,000 Texas State students swing traffic and rentals every August, I-35 clogs at rush hour, property taxes run about 2.1–2.4%, and the Blanco and San Marcos rivers flood. Tour during a semester, check FEMA maps, and file a homestead exemption if you buy.
