Case Manager

Location
Brooklyn, NY
Salary
Competitive
Posted
10/30/2017
Closes
11/29/2017
Specialty
Case Management
Contract Type
Permanent
Hours
Full Time
 
 

As one of the nation's premier centers of excellence in patient care, medical education and biomedical research, NYU Langone Health (NYULH) provides a professional environment in which nurses can perform at their best and excel in their careers. Each and every day, is a new opportunity to learn, to grow, and to be a part of what makes us world-class.

 
 

NYULH nurses can choose from many clinical services and programs to begin or mature a professional career path that can span decades. The many opportunities that are available for nurses at all levels, from new Baccalaureate RN graduates to Advanced Practice Nurses, offer the ability to deliver world class nursing care in an intellectually-stimulating academic environment. Nurses at NYULH also demonstrate their professional practice through participation in the various councils that govern the practice of nursing, the quality of our care, and the discovery of new knowledge.

 
  NYU Langone Hospital-Brooklyn is a full-service teaching hospital and Level I trauma center located in Sunset Park, Brooklyn. The medical center is central to a comprehensive network of affiliated ambulatory and outpatient practices, and serves as NYU Langone Medical Center's anchor for healthcare access, growth, and delivery in the entire borough.
Position Summary:
We have an exciting opportunity to join our team as a Case Manager.

In this role, the successful candidate The Case Manager is responsible to coordinate and ensure that the interdisciplinary plan of care and the discharge plan are consistent with the patients clinical course, continuing care needs and covered services. The Case Manager encourages and facilitates a high level of collaboration and identifies and cultivates relationships with key stakeholders.
The Case Manager utilizes an understanding of statistical & financial information to solve problems. The Case Manager participates in departmental and hospital wide process improvement activities.
Job Responsibilities:
  • Performs other duties as assigned or volunteered in alignment with NYU Langone Hospital- Brooklyn mission, goals and values
  • Conducts Performance Management monitoring and participates in problem identification and solutions to improve key processes/ systems/patient care
  • Participates in unit, departmental and hospital-based councils/activities/special projects.
  • Assimilates NYU Langone Hospital-Brooklyn's core values Dignity, Respect, Inclusivity, Compassion throughout all processes and interactions.
  • Utilizes effective conflict-resolution strategies when dealing with staff, physicians and family members.
  • Responds to patient/family needs in timely, positive manner and ensures service excellence among all staff.
  • Assumes ownership/ accountability for process improvement efforts
  • Works effectively in uncertain situations
  • Assimilates complex information and concepts
  • Responds flexibly to shifting priorities and rapid change.
  • Obtains third party payer certification for patient status change, information needed for discharge.
  • Facilitates physician discussion with medical director of third party payer in an attempt to overturn potential denial.
  • Assists in the appeal process (concurrently and retrospectively) for appeal of days and procedures.
  • Documents clinical reviews in Allscripts, and forwards same to appropriate payer as necessary.
  • Communicates salient clinical parameters through chart abstraction
  • Facilitates clinical managed care reviews to avoid technical denials
  • Collaborates with the physicians and interdisciplinary care team regarding expected LOS for specific patients utilizing MCG criteria and Medicare benchmarks. Ensures that the team is actively working towards transition to the next level of care and identified expected discharge date.
  • Prevents length of stay delays by recognizing when the acute level of care is no longer necessary and continued ongoing testing/treatment can be rendered on an outpatient basis, working with the clinical staff to ensure that such services are scheduled and approval obtained to facilitate the appropriate discharge and follow up.
  • Facilitates efficient care processes and follows through on delays in work-up, treatment and/ or discharge. Expedites testing/procedures to prevent avoidable delays and facilitate movement towards next level of care.
  • Refers potentially avoidable days to physician advisor when appropriate
  • Discusses medical necessity, as identified by the use of clinical criteria, with the interdisciplinary team to facilitate timely movement to the next level of care
  • Assesses appropriateness of patients admission, need for continued stay, level of inpatient care and discharge level of care
  • Acts as a resource to physicians/ staff regarding MCG criteria for top DRGs on CMs unit
  • Coordinates post discharge appointments with PCP to ensure cross continuum continuity of care.
  • Communicates promptly and effectively with responsible medical, nursing and ancillary staff to ensure documentation adequately reflects patient clinical status, admission status and need for continued stay.
  • Monitors patient progress toward goals
  • Provides informal education for hospital personnel that enhance their knowledge regarding clinical pathways, reimbursement issues, federal/state regulations, discharge planning issues and early recognition of post-hospital needs.
  • Encourages and facilitates high level of collaboration with medical staff, interdisciplinary team, and agencies contracted to provide continuing care services.
  • Demonstrates knowledge of disease process, available resources, and treatment modalities, assessing their quality and appropriateness for specific disabilities, illnesses and injuries.
  • Avoids potentially unnecessary days through the timely completion of the PRI and home care transfer documents. Documents avoidable days in the Allscripts system.
  • Identifies potentially unnecessary days and discusses plan of care with treatment team to reduce or eliminate same. Escalates problem as per process to eliminate delays as possible.
  • Prepares and updates PRI, using Allscripts, to reflect current changes in patient status.
  • Ensures post discharge plan of care is appropriately coordinated with and communicated to providers of post discharge care including but not limited to significant others, SNF and home care agencies
  • Demonstrates ability to implement an alternative plan for discharge when modifications are required.
  • Coordinates and ensures that the interdisciplinary plan of care and the discharge plan are consistent with the patients clinical course, continuing care needs and covered services
  • Identifies barriers to care and discharge and presents information to appropriate operational leaders to assist in the development of strategies for improvement
  • Anticipates and/or identifies discharge planning issues and effectively collaborates with the social worker, patient accounts representative, home care and /or skilled nursing facility liaison, other outpatient care representatives to address needs such as financial aid and/or post-acute service arrangements.
  • Works to ensure that patient outcomes are achieved within established timeframes using appropriate resources.
  • Demonstrates an ability to identify and shift priorities within work assignment to effectively manage patient care load.
  • Collaborates daily with interdisciplinary team for assigned patients to discuss patient care planning and care facilitation
  • Discusses estimated length of stay, treatment and discharge plan with the attending physician and patient/family. Initiates discharge planning at the time of admission, and continues throughout the inpatient stay.
  • Assesses patient needs in collaboration with the interdisciplinary team to develop a comprehensive management plan, documenting the assessment and plan in Allscripts, with printed/electronic copies to the medical record.

Minimum Qualifications:
NYS licensed RN
BSN required
At least five years relevant clinical experience with demonstrated leadership skills required.
Experience in Quality Improvement, Utilization Management, Case Management preferred.
Case Management certification preferred.
BLS required

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

NYU Langone Hospital-Brooklyn 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-Brooklyn is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision. We require applications to be completed online.
If you wish to view NYU Langone Hospital- Brooklyn's EEO policies, please click here . Please click here to view the Federal "EEO is the law" poster