RN/Case Manager-MSH-Case Management-FT-Days

About the position

The Case Manager (CM) will be responsible for all aspects of case management for an assigned group of patients to determine the appropriateness of the Level of Care, assist in the development of the plan of care; ensure that the plan is implemented in a timely basis and identify the expected length of stay (ELOS). The CM works collaboratively with physicians, social workers, clinical nurses, home care services, and other members of the interdisciplinary team as needed. The CM actively participates in specific clinical initiatives focused on reducing the length of stay (LOS), improved efficiency, quality and resource utilization. Assignment will be by units/clinical areas of practice and may require responsibility on other units/services.

Responsibilities

• Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve optimal patient outcomes and appropriate reimbursement for the organization.
• Performs continued stay reviews utilizing standardized criteria to justify continued inpatient stay.
• Collaborates with Physician and other clinicians to expedite diagnostic testing, treatment and consultations.
• Documents all clinical reviews in Case Management Documentation system.
• Supports the mission, vision, philosophy and goals of the Medical Center.
• Promotes an environment that is sensitive to cultural diversity and is open and responsive to the diverse backgrounds and experience of others.
• Assessment of the patients clinical, psychosocial, and functional status in collaboration with the interdisciplinary team.
• Identification and documentation of variances affecting the LOS and the discharge planning process.
• Conducts follow-up of any delays in treatment or reporting of results.
• Planning/developing specific goals with the physician, interdisciplinary team, and the patient and/or family.
• Implementation and coordination of specific activities, strategies, and interventions to move the patient through the continuum of care.
• Documentation of outcomes achieved and identified internal and external barriers.
• Identifies reasons for readmissions and collaborates with interdisciplinary team on strategies to reduce readmission rate.
• Appropriately identifies and refers cases to the physician advisor to support timely progression of patients along the continuum of care and (appropriate) discharge planning.
• Interacts with patient/family to discuss plan of care and coordination of services based on clinical needs and available resources.
• Maintains a working knowledge of the UR (Utilization Review) requirements of each payor within the patient population.
• Provides the clinical information requested by the managed care companies as part of the concurrent review in a timely fashion.
• Provides clinical information requested by the managed care companies in accordance with contractual agreements.
• Works collaboratively with physicians and managed care companies on concurrent denial appeals.
• Communicates clinical information to the payor, as needed, coordinating direct communication between physician and payor Medical Director as required.
• Responsible for assessment, communication and monitoring of discharge planning process.
• Obtains authorizations from managed care companies for post-discharge services.
• Assesses for clinical readiness and completes the Hospital and Community Patient Review Instrument (PRI) for patients requiring Residential Health Care Facility placement.
• Liaison with financial department for current insurance coverage.
• Develops and maintains effective working relationships with interdisciplinary team and Case Managers within the managed care organizations.
• Participates in nursing orientation.
• Interfaces with other departments in the Medical Center.

Requirements

• Bachelor's Degree in Nursing; Masters preferred.
• Previous experience in homecare, long term care or utilization review preferred.
• Discharge Planner or Case Manager preferred.
• Manager or a minimum of 3-5 years' experience as a RN in an acute care setting.
• Current NYS RN nursing license.
• CCM certification preferred.
• Re-credentialing of CCM status expected.
• PRI Certification (to be obtained within 1 year).
• Basic Life Saver (BCLS) certification.
• NRP certification (Labor and Delivery, NICU dept).
• ACLS certification (in ED; PACU/ASU; ICUs; Telemetry Units; SDU; IR, Interventional Cardiology; L&D; Endoscopy, and APN Adult Oncology).
• PALS certification (in ED; PACU; IR; Peds ICU, and APNs Pediatric Oncology depts.)

Benefits

• Salary range: $60.27 - $60.27 Hourly.
• Actual salaries depend on a variety of factors, including experience, education, and hospital need.