CASE MANAGER

Job Summary:
The Case Managers are experienced Registered Nurses who interact with the patient, families, physicians and other members of the
interdisciplinary team to facilitate quality and cost effective care. An essential component to all roles includes the evaluation of medical
necessity and intensity of service of each admission to arrive at decisions regarding medical appropriateness for the requested level of
care. Communicates with the various payers/insurance companies to authorize services and ensure appropriate reimbursement to the
facility. Actively promotes collaboration among all interdisciplinary care providers, including physicians to effectively identify needs for
continued inpatient care or appropriate alternate levels of care. There is coordination to affect an appropriate discharge plan with the
Case Managers ensuring arrangements of placement/services upon discharge. Assist to identify and make efforts to correct delays in
services, fragmentation of care and gaps in communication. Patient outcome monitoring and participation in continuous performance
improvement are also requirements in this role.
Education
Minimum:
Graduate of a Registered Nurse Program
Preferred:
Bachelor Degree in Nursing
Registration/Certification/Licensure:
Current PA RN license
Preferred: Healthcare Provider CPR
Experience
Minimum:
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 quality
patient 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 xxxxx
Middle Name xxxxx
Last Name xxxxx
Position Code 10.5070000.0000.236
Position Name CASE MANAGER
Department Name BMH Case Management
Facility Name Butler Memorial Hospital
Employee Number xxxxx
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. -FREQUENT
Stooping - To bend the body downward and forward by bending the spine at the waist. - OCCASIONAL
Bending - To flex the upper body forward. - OCCASIONAL
Twisting - To rotate the upper body forward. - OCCASIONAL
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.
CONSTANT
Up 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 the
person.
CONSTANT
Up to 20#
Lift - Floor to waist
CONSTANT
Up to 20#
Lift - Waist to shoulder
CONSTANT
Up to 20#
Lift - Shoulder to overhead
CONSTANT
Up to 20#
Carrying - To transport an object or article using the arms or hands (> 10 feet)
CONSTANT
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 - N/A
Exposure to slippery walking surfaces - N/A
Exposure to solvents, grease, oils - N/A
Exposure to radiant energy, i.e. computer terminal (more than 4 hours per shift) * - CONSTANT
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 - CONSTANT
Medium - N/A
Heavy 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) accurately
identifying Severity of Illness/Intensity of Service to determine appropriateness of admission and ensure appropriate reimbursement. Focuses on
Observation cases to determine appropriate action/follow up necessary in relationship to medical necessity; i.e. discharge/transition to inpatient
status. 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 ability
to 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 to
the facility.
4. Serves as an organizational collaborator for the patient to promote appropriate, efficient quality care. Collaborates with the Social Worker and
health care team to ensure timely discharge planning; demonstrating efficiency in arranging for patient Post Discharge Needs: home infusion
therapy, medications, DME, placement, transportation etc.
5. Remains knowledgeable and participates in ongoing performance improvement activities within the department as well as on an organizational
level; CoP (Conditions of Participation); MEIM, Freedom of Choice; Delay Days, LOS/Readmission Reduction initiatives, HF clinic referrals, identifying
barriers 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 and
works to reduce potentially unsafe patient care or other safety practices.
5. Adheres to regulatory agency requirements, survey process and compliance.