ED CLINICAL CASE MANAGER
About The Position
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.
Requirements
- Graduate of a Registered Nurse Program
- Current PA RN license
- Healthcare Provider CPR
- Act 33/73 clearances
- One year nursing experience
- 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
Nice To Haves
- Bachelor Degree in Nursing
- Past clinical experience in the assessment of behavioral health clients
- Managed care or previous Case Management/ Utilization Review experience
Responsibilities
- Assessment and coordination of emergency care
- Insurance certification and referrals
- Evaluation of medical necessity and intensity of service
- Communication with payers/insurance companies to authorize services and ensure appropriate reimbursement
- Customer service intervention in patient/family situations
- Provision of crises intervention services
- Collaboration with health care team members
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What This Job Offers
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
101-250 employees
