Case Manager, RN
Company: Northwell Careers
Location: Staten Island
Posted on: May 16, 2022
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Job Description:
Job DescriptionJob Description Serves as liaison between the
patient and facility/physician. Ensures a continuum of quality
patient care throughout hospitalization and oversees provisions for
patient's discharge. Assesses, plans, oversees and evaluates the
appropriateness of care throughout admission and hospitalization of
the patient. Job Responsibility* Facilitates patient management
throughout hospitalization.Participates in patient management
rounds and patient centered meetings.Identifies potential delays
and resolves issues with appropriate departments.Identifies
appropriate utilization of Social Work Services and makes referrals
when appropriate.Confers with physician regarding referrals for
Physical Therapy, nutrition, speech and swallow. * Serves as an
in-patient liaison - planning, assessing, implementing and
evaluating patient in collaboration with the health care
team.Serves as a resource to the health care team regarding
quality, utilization of clinical resources, payer, and
reimbursement issues.Works with on-site screeners in transitioning
patients to appropriate post discharge settings.Collaborates with
payers, providing all necessary clinical documentation for the
maximization of benefits.Serves as a liaison to patient, family,
admitting, primary care physician, health care team, and hospital
departments.Collaborates with and provides feedback to the primary
care physician and multidisciplinary team regarding patient's
status with regard to length of stay, utilization of resources and
discharge status. * Provides support to the in-patient health care
team as well as to patient and family regarding all aspects of
admission, hospitalization and discharge plan.Involves patient
and/or family in discussion and planning for anticipated need for
care following discharge.Ensures patient and/or family are given
information regarding their choices regarding transferring the
patient to another level of care according to regulatory standards.
* Performs concurrent utilization management using Interqual
criteria.Conducts chart review for appropriateness of admission and
continued length of stay.Contacts and interacts with third party
payers to obtain approval of hospital days, pre-certification and
post-discharge eligibility in relation to clinical course.Ensures
compliance with current state, federal, and third party payer
regulations.Identifies patients for Alternate Level Care (ALC) care
list and notifies appropriate health team members.Communicates with
insurance companies and physicians regarding utilization
issues.Utilizes important message from Medicare (IMM) when
appropriate.Ensures managed care reviews are up to date and
accurately reflect patient's clinical progress and acute needs. *
Participates in the quality management of patient care
outcomes.Submits data to management regarding case management
and/or quality initiatives.Participates in data collection
regarding patient's length of stay, utilization of clinical
resources, IPRO citations including appropriate recommendations and
re-admission within 30 days. * Initiates appropriate discharge
planning as supported by initial assessment at time of
admissionReviews patient's chart.Assesses each patient physically,
psychosocially and financially.Assesses patient's support system to
facilitate appropriate discharge to community.Substantiates, with
the physician, the need for home care services.Coordinates
procurement of any supplies, equipment or home lab work needed by
patient to evaluate discharge.Arranges for post-hospital
transportation, when indicated.Interacts and coordinates with
community agencies, families, vendors facilities and institutions
to facilitate patient discharge. * Documents the case management
process in the medical record.Completes and documents a
psychosocial assessment on the patient.Documents on-going processes
of patients' hospitalization.Documents finalized discharge plan and
disposition.Completes applicable areas of the Patients Discharge
Instruction Sheet and the Patient Transfer Sheet.Ensures Patient
Review Instrument (PRI) is completed and reflects clinical profile
of the patient.Ensures case management sheet is current and
accurate. * Performs related duties, as required. *ADA Essential
FunctionsJob QualificationBachelor's Degree in Nursing,
required.Current license to practice as a Registered Professional
Nurse in New York State.Case Management Certification,
preferred.Minimum of one (1) year related experience, required.
Experience in case management and clinical pathways, variance
analysis and trending, quality management/utilization review and
home care/discharge planning, preferred.Keeps abreast of
developments in the field and serves as a resource to other
staff.
Keywords: Northwell Careers, New York , Case Manager, RN, Executive , Staten Island, New York
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