Care Manager (RN) - Per Diem

NYU Langone Health • Mineola, NY

17h • Onsite

About The Position

NYU Langone Hospital—Long Island is a 591-bed university-affiliated medical center offering sophisticated diagnostic and therapeutic care. We are a major regional healthcare resource committed to medical education and research, providing a full complement of inpatient and outpatient services. At NYU Langone Health, equity and inclusion are fundamental values, striving to be a place where talented faculty, staff, and students of all identities can thrive. This role coordinates and procures services for patients' post-acute care needs, ensuring a smooth transition to the most appropriate setting. The Care Manager works collaboratively with internal and external interdisciplinary patient care staff, participates in quality improvement processes, and ensures maximization of provider reimbursement through timely insurance reviews.

Requirements

• Bachelor's degree in Nursing required for employees hired after 9/1/2020 (those hired prior are grandfathered).
• Current and valid New York State Registered Nurse License.
• BLS certification (Issued by the American Heart Association-AHA).
• 3 - 5 years Clinical acute care experience.
• Excellent communication (both oral and written) skills.
• Excellent interpersonal skills.
• Excellent organizational skills.
• Knowledge of clinical standards of practice for multiple patient populations.
• Computer skills.
• Registered Nurse License-NYS

Nice To Haves

• Bachelor's Degree Nursing.
• New York State Department of Health Patient Review Instrument (PRI) Assessor.
• 3 - 5 years Discharge planning and/or utilization management experience.
• Knowledge of post-acute care referral process for the procurement of patient services.
• Knowledge of Hospital reimbursement process, insurance denials and appeals.
• Qualified candidates must be able to effectively communicate with all levels of the organization.

Responsibilities

• Performs other duties as assigned.
• Performs an initial utilization review of patients for appropriateness of setting using industry standard utilization clinical criteria (e.g., InterQual, Milliman Care Guidelines).
• Collaborates with the Attending of record and the Physician Advisor for review of any patient not meeting criteria for the level of care ordered.
• Performs continued stay and extended stay reviews when there is a change to a higher level of acuity, authorized days expire, required by the insurance payer contractual agreement, or if a stay is denied or reduced.
• Provides patient clinical reviews to payers in a timely and efficient manner to obtain certification of patient days and secure reimbursement.
• Confers with Attending Physician, Physician Advisor, and multidisciplinary team as needed to mediate concurrent denials.
• Screens all inpatients using case management departmental screening criteria for potential post-acute care needs.
• Performs an assessment for discharge needs for all patients that meet screening criteria, are referred by the care team, or are requested by the patient/designee.
• Develops a discharge plan in collaboration with the patient/designee and care team, incorporating patient preferences.
• Implements the discharge plan with referrals, including necessary medical information, to appropriate post-acute care services.
• Conducts reassessment of the discharge process with ongoing review of all readmissions to ensure the plan was responsive to discharge needs.
• Completes all necessary documentation as per departmental policy and procedure utilizing Allscripts.
• Completes Patient Review Instrument (PRI) accurately and in a timely manner.
• Identifies and reports risk and quality issues to the appropriate department.
• Tracks avoidable days in Allscripts to identify opportunities for improvement.
• Provides patients with all necessary notices in accordance with requirements for CMS conditions of participation and insurance payer contracts, including Important Message (IM), Discharge Notice, Advanced Beneficiary Notice (ABN), Detailed Notice of non-coverage, Preadmission/Admission Notice of non-coverage, and Hospital Issuance of non-coverage (HINN) as appropriate.
• Processes Medicare Code 44 as appropriate in accordance with policy.
• Ensures patient/designee is provided with an explanation of billing status when a Code 44 or observation is ordered.
• Participates in patient care unit interdisciplinary meetings to assess patients' current and projected clinical status, plan of care, discharge plan, and expected discharge date.
• Facilitates communication among the interdisciplinary health care team members.
• Coordinates patient care conferences among appropriate team members and patient/designee to discuss identified barriers, concerns, resolve conflicts, and communicate choices in the plan of care.
• Participates in in-service activities and continuing education programs as scheduled.

Benefits

• Comprehensive benefits and wellness package.
• Robust support system for any stage of life.
• Financial security benefits.
• Generous time-off program.
• Employee resource groups for peer support.
• Holistic employee wellness program focusing on physical, mental, nutritional, sleep, social, financial, and preventive care.

What This Job Offers

• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees