EMERGENCY DEPARTMENT CLINICAL CASE MANAGER - CASUAL

Job Summary

Primary responsibilities include the assessment and coordination of emergency care, and insurance certification and referrals for a wide variety of patient groups within the continuum of care to include medical surgical patients and behavioral health patients. An essential component to this role includes the evaluation of medical necessity and intensity of service of each potential admission to arrive at decisions regarding medical appropriateness for the requested level of care. The nurse communicates with the various payers / insurance companies to authorize services and ensure appropriate reimbursement to the facility. The nurse will serve as a customer service representative to intervene in patient / family situations as necessary. The provision of crises intervention services will be required. Collaboration with all members of the health care team to facilitate the achievement of quality and cost, efficient, positive patient outcomes will be a key focus of this position.

Education

Minimum :

Graduate of a Registered Nurse Program

Preferred :

Bachelor Degree in Nursing

Registration / Certification / Licensure :

Current PA RN license, Healthcare Provider CPR, and Act 33 / 73 clearances

Experience

Minimum :

One year nursing experience.

Preferred :

Past clinical experience in the assessment of behavioral health clients. Managed care or previous Case Management / Utilization Review experience.

Other Requirements :

Excellent communication skills and skills in customer service. Demonstrates leadership ability. Commitment to the delivery of quality patient care with the ability to develop and maintain effective, professional relationships with all members of the health care team. Comprehensive Crisis Management per policy.

Status : Non-Exempt

Physical Requirements :

The following frequency definitions apply to all Physical Requirements unless otherwise noted :

Occasional : (0-1 / 3 of day , 0 - 2.5 hrs / day, 1 - 4 reps / hr)

Frequent : (1 / 3 -2 / 3 of day , 2.5 - 5.5 hrs / day, 5 -24 reps / hr)

Constant : (>

2 / 3rd of day , >

5.5 hrs / day, >

24 reps / hr)

NOTE : An asterisk (

• indicates that the item is an essential function.

Non-Material Handling

Standing

Walking

Sitting

Stooping - To bend the body downward and forward by bending the spine at the waist. - OCCASIONAL

Bending

Twisting

Climbing - To move the body in any direction on equipment or structures that do not include stairs or ladders. - N / A

Ladders - To ascend and descend ladders. - N / A

Stairs - To ascend and descend stairs. - FREQUENT

Kneeling - To move the body downwards and come to rest on both hands and both knees - OCCASIONAL

Squatting - To move the body downwards by bending both knees. - OCCASIONAL

Crouching - To bend the body forward and downward by bending the spine and the legs. - OCCASIONAL

Crawling - To move the body forward or backwards on hands and knees. - N / A

Reaching Horizontal - To extend the arms and hands outward, remaining under shoulder height - OCCASIONAL

Reaching Overhead - To extend the arms and hands up and out over shoulder height. - OCCASIONAL

Grasping - Using functional gripping of the hand to handle an object. - CONSTANT

Finger Manipulation - To manipulate objects with the use of fingers. - CONSTANT

Seeing - Using visual feedback to accomplish a task or activity. - CONSTANT

Hearing - Using sound feedback to accomplish a task or activity - CONSTANT

Repetitive Upper Extremity Use - Using the arms and / or hands continuously or more than 2 / 3 of the total time. - CONSTANT

Repetitive Lower Extremity Use - Using the legs and / or feet continuously or more than 2 / 3 of the total time. - CONSTANT

Material Handling

Pushing

FREQUENT

10# - 20#

Pulling

FREQUENT

10# - 20#

Lift - Floor to waist

OCCASIONAL

UP TO 20#

Lift

FREQUENT

20# - 50#

Lift - Shoulder to overhead

OCCASIONAL

UP TO 20#

Carrying - To transport an object or article using the arms or hands (>

10 feet)

OCCASIONAL

UP TO 20#

Environmental Factors

Working alone - OCCASIONAL

Working in cramped quarters

Constant interruptions

Working with hands in water - N / A

Use of power tools - N / A

Working on ladders / scaffolding - N / A

Exposure to vibration - N / A

Exposure to dust - N / A

Exposure to noise (constant) - N / A

Exposure to electrical energy (outlets, etc) - N / A

Exposure to termperature changes (heat, cold, humidity), that require special clothing - OCCASIONAL

Exposure to slippery walking surfaces - OCCASIONAL

Exposure to solvents, grease, oils - N / A

Exposure to radiant energy , i.e. computer terminal (more than 4 hours per shift)

Working with bloodborne pathogens - N / A

Cardiovascular Energy Requirements - Physical Demand

Physical Demand

Met Level

Examples of similar activity intensity

Sedentary to Light

0 - 3.5

Light house cleaning, washing dishes, serving food, food shopping, sitting, standing, computer work.

Medium

3.6 - 6.3

House work (mopping, scrubbing), health club exercising, treadmill work, stretching, yoga, walk / run-play with children, aerobic class, dancing, carrying bucket / wood, auto body repair, shoveling snow, golf (carrying clubs).

Heavy to Very Heavy

Calisthenics (push up, pull up, sit up, vigorous effort), carrying groceries upstairs, shoveling coal, bailing hay, fire fighting, sawing by hand, splitting wood.

As relates to this position :

Sedentary to Light - N / A

Medium

Heavy to Very Heavy - N / A