Supervisor-Care Management BSN & RN Required; 3 years of relevant experience required

NYU Langone Health•Mineola, NY

1h•Onsite

About The Position

NYU Langone Hospital—Long Island is a 591-bed university-affiliated medical center, which offers sophisticated diagnostic and therapeutic care in virtually every specialty and subspecialty of medicine and surgery. We are a major regional healthcare resource with a deep commitment to medical education and research, offering a full complement of inpatient and outpatient services. At NYU Langone Health, equity and inclusion are fundamental values. We strive to be a place where our exceptionally talented faculty, staff, and students of all identities can thrive. We embrace inclusion and individual skills, ideas, and knowledge. Position Summary: We have an exciting opportunity to join our team as a Supervisor-Care Management BSN & RN Required; 3 years of relevant experience required. In this role, the successful candidate supervises the utilization management in accordance with the Hospital Utilization Review (UR) Plan, in addition to discharge planning and progression of care management in order to promote quality of care, safe transitions in care and appropriate utilization of resources. Responsible for the coordination and maintenance of programs/processes necessary for the daily operations of the Case Management Department.

Requirements

Bachelor's Degree Nursing.
Current and valid New York State Registered Professional Nurse license.
BLS certification (Issued by the American Heart Association-AHA).
NYS DOH certification as a Patient Review Instrument (PRI) Assessor.
3 - 5 years in depth experience inclusive of acute care clinical patient care, utilization management, discharge planning, post acute care placement, and insurance denial management.
Excellent communication (both oral and written), interpersonal, strong organizational, leadership, prioritization, problem solving and deductive reasoning skills.
Knowledge of insurance denial and appeals process inclusive of external appeal, dispute resolution authority issues, commercial and government reimbursement mechanisms and managed care issues.
Enhanced understanding of utilization management, progression of care, and case management operations within the acute care Hospital setting.
Expanded clinical knowledge of standards of practice applicable to levels of patient care.
Basic computer skills including MS Office.
Qualified candidates must be able to effectively communicate with all levels of the organization.

Nice To Haves

Master's Degree Nursing.
NYS Department of Health (DOH) certification as a Screen Assessor.
1-2 years Management or supervisory.

Responsibilities

Provides for in-service educational updates as necessary for staff development. Schedules educational services to other disciplines as necessary for the promotion of quality patient care.
Participates in the development of policies and procedures of the Case Management Department inclusive of the functions of utilization management, discharge planning, post-acute care placement, and insurance denial appeals.
Oversees the departmental quality performance improvement program. Supervises staff referral of recognized quality of care issues to the Quality Management Department for assessment. Oversees the departmental quality improvement program inclusive of the maintenance of quality indicators and their measurement.
Performs other duties as assigned
Supervises departmental activities regarding utilization management and concurrent denials. Oversees completion of utilization management admission and continued stay screening and assessment procedures inclusive of the appropriate documentation according to departmental standards. Supervises the issuance of Hospital Issued Notice of Non-coverage (HINN)Notice Of Non-Coverage (NONC) Notice Of Discharge and Medicare Appeal Right (NODMAR) letters to patients as appropriate.
Oversees completion of discharge planning screening and patient assessment procedures inclusive of the appropriate medical record documentation according to departmental standards. Facilitates interdisciplinary health care team communication and coordinates case conferences as warranted. Supervises the implementation of comprehensive post-acute care discharge plans based upon in-depth assessment of patient needs inclusive of coordination of interdisciplinary and community activities. Facilitates collaborative relationships with external post-acute care agenciesfacilities.
Provides guidance and support to staff regarding progression of care management including partnering with Physician Advisors to Promote Overall Winthrop Efficiency (POWER) with unit rounds and service specific rounds.