What are the responsibilities and job description for the EMERGENCY DEPARTMENT CLINICAL CASE MANAGER - CASUAL position at Independence Health System - Westmoreland Area?
Job Details
Description
Reports to:
Director, Case Management/Preadmission Testing
Position Supervises:
N/A
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* - Remaining on one's feet in an upright position remaining stationary. - FREQUENT
Walking* - Remaining upright on one's feet, and moving about. - FREQUENT
Sitting * - Body remains in a seated position. - OCCASIONAL
Stooping - To bend the body downward and forward by bending the spine at the waist. - OCCASIONAL
Bending* - To flex the upper body forward. - FREQUENT
Twisting* - To rotate the upper body forward. - FREQUENT
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* - To exert a force upon an object in order to move it in a certain direction. Pushing refers to moving an object away from the person.
FREQUENT
10# - 20#
Pulling* - To exert a force upon an object in order to move it in a certain direction. Pulling refers to moving an object towards the person.
FREQUENT
10# - 20#
Lift - Floor to waist
OCCASIONAL
UP TO 20#
Lift* - Waist to shoulder
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 * - FREQUENT
Constant interruptions * - CONSTANT
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) * - FREQUENT
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 > 6.4 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 * - FREQUENT
Heavy to Very Heavy - N/A
Description
Reports to:
Director, Case Management/Preadmission Testing
Position Supervises:
N/A
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* - Remaining on one's feet in an upright position remaining stationary. - FREQUENT
Walking* - Remaining upright on one's feet, and moving about. - FREQUENT
Sitting * - Body remains in a seated position. - OCCASIONAL
Stooping - To bend the body downward and forward by bending the spine at the waist. - OCCASIONAL
Bending* - To flex the upper body forward. - FREQUENT
Twisting* - To rotate the upper body forward. - FREQUENT
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* - To exert a force upon an object in order to move it in a certain direction. Pushing refers to moving an object away from the person.
FREQUENT
10# - 20#
Pulling* - To exert a force upon an object in order to move it in a certain direction. Pulling refers to moving an object towards the person.
FREQUENT
10# - 20#
Lift - Floor to waist
OCCASIONAL
UP TO 20#
Lift* - Waist to shoulder
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 * - FREQUENT
Constant interruptions * - CONSTANT
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) * - FREQUENT
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 > 6.4 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 * - FREQUENT
Heavy to Very Heavy - N/A
