Description

Job Summary:The Case Managers are experienced Registered Nurses who interact with the patient, families, physicians and other members of theinterdisciplinary team to facilitate quality and cost effective care. An essential component to all roles includes the evaluation of medicalnecessity and intensity of service of each admission to arrive at decisions regarding medical appropriateness for the requested level ofcare. Communicates with the various payers/insurance companies to authorize services and ensure appropriate reimbursement to thefacility. Actively promotes collaboration among all interdisciplinary care providers, including physicians to effectively identify needs forcontinued inpatient care or appropriate alternate levels of care. There is coordination to affect an appropriate discharge plan with theCase Managers ensuring arrangements of placement/services upon discharge. Assist to identify and make efforts to correct delays inservices, fragmentation of care and gaps in communication. Patient outcome monitoring and participation in continuous performanceimprovement are also requirements in this role.EducationMinimum:Graduate of a Registered Nurse ProgramPreferred:Bachelor Degree in NursingRegistration/Certification/Licensure:Current PA RN licensePreferred: Healthcare Provider CPRExperienceMinimum:Three years recent clinical experience.Preferred: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 qualitypatient care with the ability to develop and maintain effective, professional relationships with all members of the health care team.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)First Name xxxxxMiddle Name xxxxxLast Name xxxxxPosition Code 10.5070000.0000.236Position Name CASE MANAGERDepartment Name BMH Case ManagementFacility Name Butler Memorial HospitalEmployee Number xxxxxNOTE: An asterisk (*) indicates that the item is an essential function.Non-Material HandlingStanding* - Remaining on one's feet in an upright position remaining stationary. -FREQUENTWalking* - Remaining upright on one's feet, and moving about. -FREQUENTSitting * - Body remains in a seated position. -FREQUENTStooping - To bend the body downward and forward by bending the spine at the waist. - OCCASIONALBending - To flex the upper body forward. - OCCASIONALTwisting - To rotate the upper body forward. - OCCASIONALClimbing - To move the body in any direction on equipment or structures that do not include stairs or ladders. - N/ALadders - To ascend and descend ladders. - N/AStairs - To ascend and descend stairs. - FREQUENTKneeling - To move the body downwards and come to rest on both hands and both knees - OCCASIONALSquatting - To move the body downwards by bending both knees. - OCCASIONALCrouching - To bend the body forward and downward by bending the spine and the legs. - OCCASIONALCrawling - To move the body forward or backwards on hands and knees. - N/AReaching Horizontal - To extend the arms and hands outward, remaining under shoulder height - OCCASIONALReaching Overhead - To extend the arms and hands up and out over shoulder height. - OCCASIONALGrasping - Using functional gripping of the hand to handle an object. - CONSTANTFinger Manipulation - To manipulate objects with the use of fingers. - CONSTANTSeeing - Using visual feedback to accomplish a task or activity. - CONSTANTHearing - Using sound feedback to accomplish a task or activity - CONSTANTRepetitive Upper Extremity Use - Using the arms and/or hands continuously or more than 2/3 of the total time. - CONSTANTRepetitive Lower Extremity Use - Using the legs and/or feet continuously or more than 2/3 of the total time. - CONSTANTMaterial HandlingPushing* - To exert a force upon an object in order to move it in a certain direction. Pushing refers to moving an object away from theperson.CONSTANTUp to 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 theperson.CONSTANTUp to 20#Lift - Floor to waistCONSTANTUp to 20#Lift - Waist to shoulderCONSTANTUp to 20#Lift - Shoulder to overheadCONSTANTUp to 20#Carrying - To transport an object or article using the arms or hands (> 10 feet)CONSTANTUp to 20#

Environmental FactorsWorking alone - OCCASIONALWorking in cramped quarters - FREQUENTConstant interruptions * - CONSTANTWorking with hands in water - N/AUse of power tools - N/AWorking on ladders/scaffolding - N/AExposure to vibration - N/AExposure to dust - N/AExposure to noise (constant) - N/AExposure to electrical energy (outlets, etc) - N/AExposure to termperature changes (heat, cold, humidity), that require special clothing - N/AExposure to slippery walking surfaces - N/AExposure to solvents, grease, oils - N/AExposure to radiant energy, i.e. computer terminal (more than 4 hours per shift) * - CONSTANTWorking with bloodborne pathogens - N/ACardiovascular Energy Requirements - Physical DemandPhysicalDemandMetLevelExamples of similar activity intensitySedentary toLight0 - 3.5 Light house cleaning, washing dishes, serving food, food shopping, sitting, standing, computer work.Medium 3.6 - 6.3House work (mopping, scrubbing), health club exercising, treadmill work, stretching, yoga, walk/run-playwith children, aerobic class, dancing, carrying bucket/wood, auto body repair, shoveling snow, golf(carrying clubs).Heavy to VeryHeavy> 6.4Calisthenics (push up, pull up, sit up, vigorous effort), carrying groceries upstairs, shoveling coal, bailinghay, fire fighting, sawing by hand, splitting wood.As relates to this position:Sedentary to Light - CONSTANTMedium - N/AHeavy to Very Heavy - N/A

. Specific Job Responsibilities (Essential Functions):1. Performs admission as well as continued stay review of designated cases through established decision support criteria (Interqual) accuratelyidentifying Severity of Illness/Intensity of Service to determine appropriateness of admission and ensure appropriate reimbursement. Focuses onObservation cases to determine appropriate action/follow up necessary in relationship to medical necessity; i.e. discharge/transition to inpatientstatus. Demonstrates understanding and efficiency in physician referrals/tasking to EHR.2. Provides clear documentation of selected medical necessity criteria as well as interventions and obtained authorizations. Demonstrates the abilityto navigate the Navinet On Line Highmark process, the Allscripts case management module, Meditech and EMR.3. Understands and applies the many reimbursement strategies of the various payers and makes appropriate decisions relevant to this information(i.e. per diem/DRG, case Rate, observation, etc). Completes all required authorizations/pre-certifications to ensure appropriate reimbursement tothe facility.4. Serves as an organizational collaborator for the patient to promote appropriate, efficient quality care. Collaborates with the Social Worker andhealth care team to ensure timely discharge planning; demonstrating efficiency in arranging for patient Post Discharge Needs: home infusiontherapy, medications, DME, placement, transportation etc.5. Remains knowledgeable and participates in ongoing performance improvement activities within the department as well as on an organizationallevel; CoP (Conditions of Participation); MEIM, Freedom of Choice; Delay Days, LOS/Readmission Reduction initiatives, HF clinic referrals, identifyingbarriers to discharge, fragmentation in patient care, etc.II. Organizational Responsibilities:1. Completed mandatory education, annual competencies and department specific education within established timeframes.2. Completed annual employee health requirements within established timeframes.3. Maintained license/certification, registration in good standing throughout fiscal year.4. Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self. Identifies andworks to reduce potentially unsafe patient care or other safety practices.5. Adheres to regulatory agency requirements, survey process and compliance.

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