Nurse, Case Management - FT Day
Company: NYU Langone Health
Location: Mineola
Posted on: January 15, 2021
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Job Description:
NYU Winthrop 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.Position Summary:We have an
exciting opportunity to join our team as a Nurse - Case Mgmt. 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 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 Beneficary
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 patientdesignee is
provided with eplanation 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.* Performs other duties as assignedMinimum
Qualifications:To qualify you must have a Associate's Degree
Nursing. Current and valid New York State Registered Nurse License.
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-NYSPreferred 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 Winthrop 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 Winthrop 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 Winthrop's EEO policies, please
click here. Please click here to view the Federal "EEO is the law"
poster or visit
https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm for
more information. To view the Pay Transparency Notice, please click
here.
Keywords: NYU Langone Health, New York , Nurse, Case Management - FT Day, Executive , Mineola, New York
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