Position Summary:We have an exciting opportunity to join our team as a
Care Manager (RN) **Hospital Care Management Experience Highly Preferred** (Sunday-Thursday, 8:00AM-4:00PM).
In this role, the successful candidate coordinates and procures services necessary to meet the post-acute care needs of patients identified as requiring such services. Ensures a timely and smooth transition to the most appropriate post-acute care setting. Works collaboratively with interdisciplinary patient care staff both internal and external to the organization. Participates in quality improvement and evaluation processes related to the management of patient care. Ensures maximization of provider reimbursement of patient days through timely and accurate insurance reviews.
Job Responsibilities:- Performs other duties as assigned
- Performs an initial utilization review of patients for appropriateness of setting using industry standard utilization clinical criteria including, but not limited to InterQual, Milliman Care Guidelines (MCG), etc. Collaborates with the Attending of record and the Physician Advisor as indicated for review of any patient not meeting criteria for level of care ordered. Performs continued stay and extended stay reviews when there is a change to a higher level of acuity, authorized days expire, required by the insurance payer contractual agreement, stay is denied or reduced to a lower level of care.
- Provides patient clinical reviews to payer in a timely and efficient manner to obtain certification of the patient days and secure reimbursement. Confers with Attending Physician, Physician Advisor, and multidisciplinary team as needed to mediate concurrent denials.
- Screens all inpatients utilizing case management departmental screening criteria for potential post acute care needs. Perform an assessment for discharge needs for all patients that meet screening criteria, are referred by care team or are requested by patient/designee. Develops a discharge plan in collaboration with the patient/designee and care team incorporating patient preferences. Implement the discharge plan with referrals, including necessary medical information, to appropriate post acute care services. Reassessment of this process will be done with ongoing review of all readmissions to ensure that the plan was responsive to the discharge needs.
- Completes all necessary documentation as per departmental policy and procedure utilizing Allscripts. Completes Patient Review Instrument (PRI) accurately and in a timely manner.
- Identifies and reports risk and quality issues to appropriate department. Tracks avoidable days in Allscripts to identify opportunities for improvement.
- Provides patients with all necessary notices in accordance with requirements for CMS conditions of participation and insurance payer contracts. Issue Important Message (IM), Discharge Notice, Advanced Beneficiary Notice (ABN), Detailed Notice of non-coverage, Preadmission/Admission Notice of non-coverage and Hospital Issuance of non-coverage (HINN) as appropriate and in accordance with hospital policy and procedure. Process Medicare Code 44 as appropriate in accordance with policy. Ensure patient designee is provided with explanation of billing status when a Code 44 or observation is ordered.
- Participates in patient care unit interdisciplinary meetings to assess patients' current and projected clinical status, plan of care, discharge plan and expected discharge date. Facilitates communication among the interdisciplinary health care team members. Coordinates patient care conferences among appropriate team members and patient/designee to discuss identify barriers, concerns, resolve conflicts and communicate choices in the plan of care. Participates in in-service activities and continuing education programs as scheduled.
Minimum Qualifications:To qualify you must have a Bachelor's degree in Nursing required for employees hired after 9/1/2020 (those who were hired prior to 9/1/2020 are grandfathered). Current and valid New York State Registered Nurse License. BLS certification (Issued by the American Heart Association-AHA). 3 - 5 years Clinical acute care. Excellent communication (both oral and written), interpersonal, organizational skills. Knowledge of clinical standards of practice for multiple patient populations. Computer skills..
Required Licenses: Registered Nurse License-NYS
Preferred Qualifications:Bachelor's Degree Nursing. New York State Department of Health Patient Review Instrument (PRI) Assessor. 3 - 5 years Discharge planning and/or utilization management. Knowledge of post-acute care referral process for the procurement of patient services. Knowledge of Hospital reimbursement process, insurance denials and appeals.
Qualified candidates must be able to effectively communicate with all levels of the organization.
NYU Langone Hospital-Long Island provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.
At NYU Langone Health, we are committed to supporting our workforce and their loved ones with a comprehensive benefits and wellness package. Our offerings provide a robust support system for any stage of life, whether it's developing your career, starting a family, or saving for retirement. The support employees receive goes beyond a standard benefit offering, where employees have access to financial security benefits, a generous time-off program and employee resources groups for peer support. Additionally, all employees have access to our holistic employee wellness program, which focuses on seven key areas of well-being: physical, mental, nutritional, sleep, social, financial, and preventive care. The benefits and wellness package is designed to allow you to focus on what truly matters. Join us and experience the extensive resources and services designed to enhance your overall quality of life for you and your family.
NYU Langone Health provides a salary range to comply with the New York state Law on Salary Transparency in Job Advertisements. The salary range for the role is $147,153.96 - $180,190.08 Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.
To view the Pay Transparency Notice, please click here
