Emergency Department Case Manager

About the role

The Emergency Department Case Manager works within Kingman Healthcare’s Case Management department to screen, assess, and coordinate care for patients presenting to the ED and throughout their hospital stay. The role collaborates with physicians, nurses, social workers and other staff to ensure appropriate level of care, utilization review, and safe discharge planning.

Key responsibilities

• Screen ED patients with providers to determine admission necessity, appropriate level of care, and identify alternatives to admission.
• Perform utilization review on all admitted patients, applying MCG criteria to assess medical necessity and appropriate resource use.
• Develop, document, and implement individualized discharge plans, coordinating post‑hospital services and educating patients and families.
• Identify and arrange community resources, skilled nursing, home health, durable medical equipment and other services to support patient transitions.
• Communicate medical necessity and coverage determinations with payers, ensuring compliance with KHI policies.
• Participate in multidisciplinary rounds, sharing assessments and updates to align the care team on patient needs.
• Ensure accurate and timely documentation of assessments, reassessments, and discharge plans in required systems.
• Support compliance with regulatory and hospital policies, including reporting, committee participation, and quality improvement activities.