An emergency room is a dynamic work setting that has plenty of healthcare workers with different specialties.
Doctors, nurses, nursing assistants, laboratory staff, nurse practitioners, physician assistants, and sometimes even a case manager, work together in an emergency room.
In the emergency room, the position of a case manager is usually filled by registered nurses according to their clinical experience.
The most important part of the role of a nurse case manager in the emergency room is to manage patients and distribute them to the appropriate level of care.
The decision-making process may involve deciding on hospitalization, utilizing hospital resources to promote cost-effectiveness, safe discharge planning, and improvement of patent satisfaction in all fields.
However, not all emergency rooms need a nurse case manager.
Also, a nurse case manager can sometimes be asked to complete the UR – Utilization Review.
The UR refers to the review which ensures that a patient doesn’t receive any unnecessary care which will result in increased costs.
The UR is usually done by submitting reviews to the insurance companies, to make sure that services are properly covered.
A unique role of a nurse case manager in emergency rooms is in management all patients that come through the door by classifying them as those who meet inpatient criteria for admission and those who need additional services for a discharge.
Nurse case managers in the ER can assist in placing the patient in a skilled nursing facility for short-term rehabilitation (PT/OT).
Their task is to obtain authorization from insurance to provide coverage as well.
Nurse case managers also help in arranging home health services (PT/OT/RN) and get authorization from insurance to provide coverage for those services.
Obtaining Durable Medical Equipment (DME) – wheelchairs, etc. is also part of their job, as well as dealing with insurance issues for the cost coverage.
Nurse case managers are in charge of setting patients on hospice services from the ER, they make a follow-up appointment to ensure the patient is seen promptly and help to connect the patient to outpatient case management services.
Sometimes, when a nurse case manager works with uninsured or underinsured patients, they can struggle to ensure safe discharge.
If that happens, a nurse case manager can contact social workers to help them ensures appropriate resources for the best patient care.