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Nurse, Case Management - FT Day

Company: NYU Langone Health
Location: Mineola
Posted on: January 15, 2021

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 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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