Care Manager RN - Full Time, Days

NYU Langone Hospital-Suffolk is a 306-bed medical center, providing care to residents of eastern Long Island. The hospital facility is home to theKnapp Cardiac Care Center-an advanced heart disease diagnostic and treatment facility-as well as a modern ambulatory surgical pavilion with specialized services including women's imaging, a sleep laboratory, and bariatric surgery. Our Provisional Level 2 Trauma Center delivers comprehensive and specialized care for patients with traumatic injuries. The Stroke Center at NYU Langone Hospital-Suffolk is designated by the New York State Department of Health as a Primary Stroke Center, with expert neurologists available to provide treatment 24 hours a day, 7 days a week. Additionally, NYU Langone Hospital-Suffolk has multiple outpatient sites, including an outpatient wound care center, a hemodialysis center, and various primary care and specialty offices. For more information, go toNYU Langone Hospital-Suffolk , and interact with us onLinkedIn,Glassdoor,Indeed,Facebook,Twitter,YouTubeandInstagram.

Position Summary:
We have an exciting opportunity to join our team as a Care Manager RN - Care Management - 8:00 AM - 04:00 PM Monday - Friday with one weekend a month.

The RN Care Manager collaborates with the interdisciplinary team to implement the plan of care and transition strategies ensuring the achievement of desirable patient outcomes appropriate length of stay efficient utilization of resources increased patient and family involvement and patient/staff/family education Implementation is accomplished through patient assessment monitoring of the plan of care review activities coordination with the interdisciplinary team and any outside third party payers communicating with physicians performing utilization management activities to avoid denials reduce avoidable delays and control costs where possible and by facilitating continuity of care across settings

Job Responsibilities:

Utilization Management

Demonstrates accountability for utilization management functions and communication with payers to assure authorization and payment for hospital stay
Performs admission review within 24 hours of admission on all patients in case load utilizing InterQual Criteria to determine if patient meets medical necessity for admission
Initiates contact with attending physician to solicit additional information to support medical necessity for admission when there is not adequate information in the medical record
Suggests alternative level of care/treatment plan for patients not meeting medical necessity for admission
Refers cases for second level review that do not meet medical necessity or level of care requirements according to department procedure
Documents review in Soft Med according to department procedure
Submits reviews to third party payors according to contract requirements in a timely manner
Assures days are approved and information is entered in Soft Med in a timely manner
Follows up with third party payors when there is a lack of response to request for authorization
Advocates for the patient family physician and facility to obtain benefits from third party payors and others that provide financial assistance
Communicates with patients and families to ensure understanding of third party payor guidelines
Conducts continued stay review as indicated based on clinical condition and third party payor requirements
Collaboratively institutes prevention plans to avoid third party payor denials and problems solves with the health care team when denials are received
Manages concurrent denial/appeal process in collaboration with the UR Specialist
On a concurrent basis assesses the appropriateness and timeliness of the level of care diagnostic testing and clinical procedures quality and clinical risk issues and documentation completeness
Issues denial letters as indicated according to department procedure
Acts collaboratively to resolve resource issues keeping manager/director informed as needed
Refers cases with complex psychosocial and medical issues to the social worker according to department guidelines
Communicates with the attending physician to clarify information regarding the plan of care as needed
Escalates cases not meeting continued stay criteria or when an alternative level of care is more appropriate when barriers to care progression are unresolved according to department procedure

Discharge Planning

Leads and implements the transition planning process from the time of admission to discharge by effectively assessing patient/family needs preferences and available resources
Completes a discharge planning assessment for all patients in assigned case load within 24 hours of admission
Confers with attending physician and other members of the health care team to identify needs
Documents all pertinent information in the electronic medical record
Serves as a resource and advocate for patients/families by providing information regarding available resources appropriate for the patient rsquo;s discharge plan and third party payer guidelines
Communicates with patient/family to ensure understanding of anticipated discharge date and involvement in planning for care after discharge in a consistent and timely manner
Refers cases with complex psychosocial and or medical issues that may create barriers to discharge to the social worker according to department guidelines
Completes the PRI in a timely manner as indicated
Initiates referral to facilities and agencies that can meet the post hospital care needs of the patient and are authorized by third party payors
Ensures patients right to choice in providers of post hospital care by providing a list of agencies and facilities that can meet the patient rsquo;s care needs
Ensures continuity of care by acting as a liaison between the hospital and community resources
Provides all required information to the agency/facility to facilitate a smooth transition
Maintains positive working relationships with community agencies and facility staff to maximize access for patients/families
Keeps up to date on available community resources and regulatory requirements that impact discharge planning
Provides input to the development of processes that improve continuity transitions and patient centered care across the continuum of care

Care Progression

Identifies anticipated discharge date at the time of admission in collaboration with the members of the health care team
Ensures that the patient/family is aware of the plan of care and anticipated length of stay
Monitors patient's plan of care and progress in relation to anticipated length of stay and intervenes to facilitate a timely discharge
Attends daily Patient Care Progression Rounds and follows up on any issues/barriers identified with the appropriate staff/departments
Facilitates communication among team members to resolve issues that may impact the plan of care
Encourages interventions appropriate to the reason for the patient's admission
Initiates referrals to the appropriate areas to expedite care treatment and services SW PT speech therapy financial counselor palliative care etc
Seeks input from clinical experts to explore acceptable alternatives to treatment plan
Identifies and documents avoidable delays in care and works collaboratively the healthcare team to prevent them
Escalates cases with unresolved issues according to department guidelines

Minimum Qualifications:
To qualify you must have a Current NYS Registered Nursing License B S or M S preferred Case Management certification from accepting accrediting body preferred Minimum 5 years of clinical medical surgical experience and 3 5 years experience as a hospital in patient Case manager Must possess knowledge of Federal and State regulations pertaining to hospital reimbursement the utilization review process and the discharge planning function Knowledge of identification assessment and intervention pertaining to high risk populations Working knowledge of/completion of CDI Clinical Documentation Implementation Training Working knowledge/experience with hospital/care management software documenting electronically and compiling data from the electronic medical record Working knowledge of Microsoft outlook Microsoft Word Excel PowerPoint and scanning PRI and Screen certifications preferred.

Required Licenses: Registered Nurse License-NYS

Preferred Qualifications:
Case Management experience hospital or insurance company experience preferred Recent adult hospital experience preferred

Qualified candidates must be able to effectively communicate with all levels of the organization.

NYU Langone Hospital-Suffolk 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.

NYU Langone Hospital-Suffolk is an equal opportunity employer and committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration. We require applications to be completed online.

ViewNYU Langone Hospital-Suffolk's Equal Employment Opportunity (EEO) policy. Know Your Rights: Workplace discrimination is illegal.

NYU Langone Hospital-Suffolk 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 $110,353.08 - 143,335.48 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.

View the Pay Transparency Notice for further details.