Care Manager (RN) Hospital Care Management Experience Highly Preferred (Sunday-Thursday, 8:00AM-4:00PM)

NYU Langone Health • Mineola, NY

43d • Onsite

About The Position

NYU Langone Hospital—Long Island is a 591-bed university-affiliated medical center providing comprehensive medical and surgical care. As a major regional healthcare resource, we are dedicated to medical education and research, offering a full spectrum of inpatient and outpatient services. At NYU Langone Health, we value equity and inclusion, fostering an environment where talented faculty, staff, and students of all identities can thrive. We embrace diversity and individual contributions.

This role involves coordinating and procuring services to meet the post-acute care needs of identified patients, ensuring a smooth transition to the most appropriate setting. The Care Manager collaborates with internal and external interdisciplinary patient care staff, participates in quality improvement initiatives, and ensures maximization of provider reimbursement through timely and accurate insurance reviews.

Requirements

• Bachelor's degree in Nursing required for employees hired after 9/1/2020 (those who were hired prior to 9/1/2020 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.
• Excellent communication (both oral and written), interpersonal, organizational skills.
• Knowledge of clinical standards of practice for multiple patient populations.
• Computer skills.
• Registered Nurse License-NYS

Nice To Haves

• Hospital Care Management Experience Highly Preferred
• Bachelor's Degree Nursing.
• New York State Department of Health Patient Review Instrument (PRI) Assessor.
• 3 - 5 years Discharge planning and/or utilization management.
• 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 an initial utilization review of patients for appropriateness of setting using industry standard utilization clinical criteria including, but not limited to InterQual, Milliman Care Guidelines (MCG), etc.
• Collaborates with the Attending of record and the Physician Advisor as indicated for review of any patient not meeting criteria for 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, stay is denied or reduced to a lower level of care.
• Provides patient clinical reviews to payer in a timely and efficient manner to obtain certification of the patient days and secure reimbursement.
• Confers with Attending Physician, Physician Advisor, and multidisciplinary team as needed to mediate concurrent denials.
• Screens all inpatients utilizing case management departmental screening criteria for potential post acute care needs.
• Perform an assessment for discharge needs for all patients that meet screening criteria, are referred by care team or are requested by patient/designee.
• Develops a discharge plan in collaboration with the patient/designee and care team incorporating patient preferences.
• Implement the discharge plan with referrals, including necessary medical information, to appropriate post acute care services.
• Reassessment of this process will be done with ongoing review of all readmissions to ensure that the plan was responsive to the 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 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.
• Issue 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 and in accordance with hospital policy and procedure.
• Process Medicare Code 44 as appropriate in accordance with policy.
• Ensure patient designee is provided with 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 identify barriers, concerns, resolve conflicts and communicate choices in the plan of care.
• Participates in in-service activities and continuing education programs as scheduled.
• Performs other duties as assigned

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level