RN Case Manager

Stony Brook University•Stony Brook, NY

17d

About The Position

At Stony Brook Medicine, a RN Case Manager is a valuable member of our team, who provides clinical services to our patient population. Qualified candidates will demonstrate superior patient care and possess outstanding communication skills while adhering to our high standard of excellence. Duties of a RN Case Manager in the Care Management Department may include the following but are not limited to: Completes Utilization review screen for inpatient and observation cases. Activity includes UR from the Emergency Room or on the unit to ensure guidelines are reviewed and the plan of care is discussed with the team. Works closely with the Case Managers and Social Workers on the units and reviews findings with them. Ensures that patients are placed in the correct level of care from initial assess point. Follows cases for authorization for in patient stay. Staff review short stay, long stay and complex cases to affect and ensure a safe discharge plan. Completes retrospective review, one and two day short stay reviews and other projects as assigned. Identifies, follows and documents Avoidable delays in Care Management Program. Reviews and documents on patients who were readmitted within thirty days. Documents over utilization of resources and services. All Medicare cases are reviewed for level of care on admission. Reviews with the Attending, any patient who does not meet in-patient criteria for admission. Follows the process for Code 44 on Medicare patients. Follow the process for Code 44 on all other payers. Active participation with the physician and payer to prevent denials. Reviews cases for potential change in level of care with the CM and physician. Communicates with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals. Consistent documentation in the EMR regarding acuity, plan of care and communication with the team. Charting includes data for authorization and data management. Reviews cases daily from admission through discharge to prevent denials.This includes patient and family contacts, insurance authorizations, tests, procedures, community resources etc. Assistants with coordination for discharge planning including patient and family education with the interdisciplinary team. Coordinates transitional care planning for outpatient resources, prepares PRI for early referrals and contacts with agencies and facilities throughout the hospital stay. Actively involved in performance improvement activities including program development, data collection and analysis. Maintain high level customer service. All unit coverage as needed and other duties as required.

Requirements

A Bachelor’s degree or a nurse working on their degree with an RN license and working history of 5 years in hospital setting.
A candidate should have a good understanding of the admission/discharge process.
They need good interpersonal skills to work with all team members.
They need to document accurately and be able to prioritize their work and follow up with cases.

Nice To Haves

CM, UM, Quality, Coding, Risk or MCG Certification
Working knowledge of MCG or Interqual
PRI Certified
Knowledge of regulatory requirements
Bilingual
Recent experience in tertiary care
Experience in pediatrics, NICU, Mother/Baby or ED
Leadership skills
Master’s prepared.

Responsibilities

Completes Utilization review screen for inpatient and observation cases.
Works closely with the Case Managers and Social Workers on the units and reviews findings with them.
Ensures that patients are placed in the correct level of care from initial assess point.
Follows cases for authorization for in patient stay.
Staff review short stay, long stay and complex cases to affect and ensure a safe discharge plan.
Completes retrospective review, one and two day short stay reviews and other projects as assigned.
Identifies, follows and documents Avoidable delays in Care Management Program.
Reviews and documents on patients who were readmitted within thirty days.
Documents over utilization of resources and services.
All Medicare cases are reviewed for level of care on admission.
Reviews with the Attending, any patient who does not meet in-patient criteria for admission.
Follows the process for Code 44 on Medicare patients.
Follow the process for Code 44 on all other payers.
Active participation with the physician and payer to prevent denials.
Reviews cases for potential change in level of care with the CM and physician.
Communicates with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals.
Consistent documentation in the EMR regarding acuity, plan of care and communication with the team.
Reviews cases daily from admission through discharge to prevent denials.
Assistants with coordination for discharge planning including patient and family education with the interdisciplinary team.
Coordinates transitional care planning for outpatient resources, prepares PRI for early referrals and contacts with agencies and facilities throughout the hospital stay.
Actively involved in performance improvement activities including program development, data collection and analysis.
Maintain high level customer service.
All unit coverage as needed and other duties as required.