Case Manager, RN- Case Management/Princes Bay

Northwell • New York, NY

1d • $61 - $79 • Onsite

About The Position

The Case Manager, RN will facilitate patient management throughout hospitalization, serve as an in-patient liaison, provide support to the in-patient health care team, perform concurrent utilization management, participate in quality management of patient care outcomes, initiate appropriate discharge planning, and document the case management process in the medical record. This role also involves performing related duties as required.

Requirements

• Bachelor’s Degree in Nursing, required.
• Current license to practice as a Registered Professional Nurse in New York State.
• Minimum of one (1) year related experience, required.
• Patient Review Instrument certification required.

Nice To Haves

• Case Management Certification, preferred.
• Experience in case management and clinical pathways, variance analysis and trending, quality management/utilization review and home care/discharge planning, preferred.

Responsibilities

• Facilitates patient management throughout hospitalization, including participating in patient management rounds and meetings, identifying and resolving potential delays, identifying and referring to Social Work Services, and conferring with physicians regarding referrals for various therapies.
• Serves as an in-patient liaison, planning, assessing, implementing, and evaluating patients in collaboration with the health care team. Acts as a resource for quality, utilization of clinical resources, payer, and reimbursement issues. Works with on-site screeners for post-discharge transitions, collaborates with payers for benefit maximization, and serves as a liaison to patients, families, physicians, and hospital departments. Provides feedback to the primary care physician and multidisciplinary team regarding patient status.
• Provides support to the in-patient health care team, patients, and families regarding admission, hospitalization, and discharge planning. Involves patients and/or families in planning for post-discharge care and ensures they receive information regarding transfer options.
• Performs concurrent utilization management using Interqual criteria, including chart review for appropriateness of admission and continued stay. Contacts third-party payers for approval of hospital days and post-discharge eligibility. Ensures compliance with regulations, identifies patients for Alternate Level Care (ALC), communicates with insurance companies and physicians regarding utilization issues, utilizes important message from Medicare (IMM) when appropriate, and ensures managed care reviews are up to date.
• Participates in the quality management of patient care outcomes by submitting data to management regarding case management and quality initiatives, and participating in data collection related to length of stay, resource utilization, IPRO citations, and re-admissions.
• Initiates appropriate discharge planning based on initial assessment. Reviews patient charts, assesses patients physically, psychosocially, and financially, and assesses the patient's support system. Substantiates the need for home care services with the physician, coordinates procurement of necessary supplies or equipment, arranges for post-hospital transportation, and interacts with community agencies, families, vendors, facilities, and institutions to facilitate discharge.
• Documents the case management process in the medical record, including psychosocial assessments, ongoing hospitalization processes, finalized discharge plans, and applicable discharge and transfer sheets. Ensures Patient Review Instrument (PRI) and case management sheets are current and accurate.
• Performs related duties as required.

What This Job Offers

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