The Managed Care Coordinator supports the behavioral health inpatient programs by implementation or investigation of the procedures in the Utilization Review and Discharge Planning program at Westchester Medical Center. In addition, the Managed Care Coordinator monitors length of stay and resource consumption of patients; evaluates, investigates and reports on hospital incidents; assists with developing procedures to improve patient care and assist in carrying out aspects of Quality improvement to ensure that Westchester Medical Center continues to meet the medical standards for patient care prescribed by accrediting, licensing and reimbursement agencies
Experience:
Minimum of 3-5 years experience in Acute Behavioral Health clinical specialty.
Three years of experience where the primary function of the position was nursing in a hospital or health care agency, one of which must have been at a leadership level, and one year of which must have been in either a hospital, health care agency or managed care company in the area of utilization review, quality assurance, risk management or discharge planning.
Education and Training:
Graduation from an accredited school of nursing with a Baccalaureate Degree preferred.
Substitution: Satisfactory completion of 30 credits at a recognized college or university in a Bachelor's* or Master's Degree* Nursing program may be substituted for one year of the general nursing experience above.
License, Certification and Registration:
Possession of a valid license and current registration, issued by the New York State Department of Education, as a registered professional nurse and
Other Requirements:
Thorough knowledge of application of current nursing techniques and procedures; thorough knowledge of the New York State Nurse Practice Act, Knowledge of regulatory agency standards; Centers for Medicare & Medicaid Services, Office of Mental Health and Det Norske Veritas (DNV) standards; ability to review, analyze and investigate Quality Assurance standards of patient care and identify deficiencies; ability to collaborate with other areas of hospital operations and administration; ability to communicate effectively both orally and in writing; ability to set priorities; ability to effectively use computer applications such as spreadsheets, word processing, calendar, e-mail and database software in performing work assignments; ability to read, write, speak, understand, and communicate in English sufficiently to perform the essential duties of the position; initiative; professional competence; sound judgment; physical condition commensurate with the demands of the position.
