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Exemption Status:

Non-Exempt

Hiring Range:

$52.50 - $57.50

Please note that the final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations.

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 a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

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. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

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. The POE/ED CM manages patient flow through the ED by evaluating incoming patients and assisting in determining appropriate discharge disposition (Home, Post-acute Services, Inpatient, or Observation). This includes early assessment of discharge needs and communication among healthcare team members and family/caregivers. The POE/ED CM collaborates with admitting teams to ensure correct initial admission status using InterQual criteria.

I. Major Responsibilities:

Patient Identification and Communication

1.   Reviews all ED patients promptly.

2.   Reviews all admitted patients within one hour of admission or before admitting orders are placed.

3.   Intervenes early for patients with progressive conditions or complex needs.

4.   Ensures communication among MSW, CM, and ED care team.

Assessment and Documentation

1.   Completes and documents initial discharge planning assessments.

2.   Refers complex or high-utilizer patients for MSW psychosocial assessment.

3.   Identifies and documents readmissions for follow-up.

Utilization Review

1.   Completes admission reviews using InterQual criteria.

2.   Collaborates with providers to resolve discrepancies in medical necessity.

3.   Documents clinical reviews in Meditech per standards.

Discharge and Transition Planning

1.   Executes discharge plans in collaboration with ED and admitting physicians.

2.   Prioritizes discharges requiring post-acute care arrangements.

3.   Arranges services such as Home Health, DME, SNF, rehab, and medications.

Escalation and Issue Resolution

1.   Escalates unresolved cases to appropriate leadership.

2.   Follows formal escalation processes for utilization and level of care issues.

3.   Documents avoidable delays for boarded ED patients daily.

Age-Specific Competency

1.   Applies knowledge of growth and development stages to patient care.

2.   Demonstrates age-appropriate communication and support.

II. Position Qualifications:

License/Certification/Education

Required:

1.   Bachelor of Science in Nursing

2.   Current Massachusetts RN license

Preferred:

1.   CCM certification

Experience/Skills

Required:

1.   Minimum 3 years of medical, surgical, ICU, or ED nursing experience

2.   Demonstrated sound judgment and knowledge of medical care and support services

3.   Excellent interpersonal and communication skills

4.   Analytical ability to evaluate patient care needs and service appropriateness

Preferred:

1.   3–5 years of hospital-based case management

2.   Emergency department experience

3.   Utilization review experience

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

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.

We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.