Care Manager, Registered Nurse, ED/Obs (Night Shift)
Company: NYU Langone Health
Location: New York
Posted on: January 15, 2021
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Job Description:
NYU Langone Health is a world-class, patient-centered,
integrated academic medical center, known for its excellence in
clinical care, research, and education. It comprises more than 200
locations throughout the New York area, including five inpatient
locations, a children's hospital, three emergency rooms and a level
1 trauma center. Also part of NYU Langone Health is the Laura and
Isaac Perlmutter Cancer Center, a National Cancer Institute
designated comprehensive cancer center, and NYU Grossman School of
Medicine, which since 1841 has trained thousands of physicians and
scientists who have helped to shape the course of medical history.
For more information, go to nyulangone.org, and interact with us on
LinkedIn, Glassdoor, Indeed, Facebook, Twitter, YouTube--and
Instagram.Position Summary:We have an exciting opportunity to join
our team as a Care Manager. In this role, the successful candidate
Coordinates, negotiates, procures, and manages the care of patients
by providing focused care coordination across the acute care
continuum. Evaluates appropriate clinical resource utilization, and
assesses patients for transitioning to the next appropriate level
of care through review of patient records and information derived
from interdisciplinary rounds. Collaborates with the health care
team to ensure the achievement of quality outcomes for
patients/familiesJob Responsibilities:* Assesses patient and
medical record documentation for appropriate acute admission and
level of care, quality and safety indicators, and plans for
discharge. Assesses patient and medical record documentation to
identify medical necessity and appropriateness of admission and
continued stay using pre-established clinical criteria (i.e.,
Milliman Care Guidelines, CMS) according to hospital policy.
Ensures that the physicians documentation supports level of care.
Collaborates with physician when additional documentation needed to
support level of care. Communicates appropriate level of care to
the health care team. Utilizes patient assessment information to
identify quality and safety indicators to monitor during hospital
stay. Performs initial and ongoing assessment of patient/family
needs for discharge planning and communicates findings to
interdisciplinary team.* Performs systematic assessment and
reassessment of patient and family/significant other considering
clinical presentation, cultural and religious influences,
individual experiences, available resources, environmental factors
as well as health behaviors and practices. Considers all aspects of
patient/family assessment findings. Understands medical plan of
care and is able to communicate pertinent findings from patient
assessment. Monitors medical plan of care to determine outcome of
treatment and revise patient assessment as necessary. Facilitates
appropriate consults based on patient assessment to ensure timely
delivery of care. Identifies cultural and religious influences on
illness.* Formulates the plan of care, along with the patient and
family, based on communication with the attending physician(s),
expected goals of care and length of stay; articulates knowledge of
the plan of care through an understanding of patients diagnosis,
prognosis, care needs, and desired outcomes. Considers assessment
findings and collaborates with the attending physician
(s)/hospitalist to establish the expected goals of care and LOS.
Collaboratively participates in the development of an
interdisciplinary plan of care that is individualized to the
patients condition or needs. Focuses the care plan on quality of
life, effective utilization of resources, and facilitates goal
achievement and movement through the continuum of care. Proactively
identifies hospital services and available resources to meet
patients needs. Reviews patient history and re-assess prognosis and
care needs to achieve desired outcomes. Assesses patient/family
needs for advance care planning. Confers with attending
physician/hospitalist and health care team regarding variances from
anticipated plan of care.* Works collaboratively with attending
physician, consulting physician(s) and other disciplines to
identify, develop, implement and coordinate an appropriate plan of
care that maximizes individual patient/family preference and
enhances quality, access, and cost-effective outcomes. Ensures
patients individualized plan of care is collaborative and
multidisciplinary by working with patient/family, attending
physician/hospitalist and health care team members. Coordinates
care based on individual needs, expected goals and length of stay.
Facilitates interdisciplinary plan of care interventions.
Communicates effectively with attending physician/hospitalist and
members of health care team to enhance patient care in a positive
environment.* Assesses patient and family responses to
interdisciplinary plan of care and care management interventions,
and adapts interventions to achieve optimal outcomes. Collaborates
with patient, family, interdisciplinary team for agreement with
treatment goals, timeframes and coordination of care. Works with
the interdisciplinary team to facilitate adjustments to the care
plan to promote enhanced outcomes. Intervenes as care manager in a
manner that is consistent with the established plan of care.
Prioritizes and organizes interventions. Implements interventions
in a safe, timely and appropriate manner.* Documents assessments,
findings, progress, interventions and recommendations in a care
management software system and/or medical record according to
established standards. Documentation meets standards in accordance
with departmental and hospital policy and procedures. Documents
assessments, findings, progress, interventions and recommendations
in Canopy and ECIN Care Management and ICIS systems within
established timeframes. Documents revisions in diagnoses, plan of
care and outcomes. Documents patients responses to interventions
with appropriate consideration of patient confidentiality.* Applies
customary protocols, pathways, evidence-based processes and other
means of managing patient care. Utilizes protocols, pathways and
order sets to formulate, communicate and ensure implementation of
the patient plan of care. Utilizes multidisciplinary team to
address individualized patient needs. Develops realistic goals with
multidisciplinary team for patient to achieve milestone activities
within appropriate timeframes. Demonstrates flexibility with plan
of care to meet patient needs..* Supports the mission, philosophy,
standards, goals and objectives of NYU Hospitals Center and Care
Management Program. Contributes to the development of the goals and
objectives of the Care Management Program consistent with the
objectives of NYU Hospitals Center. Understands, applies and
supports departmental/hospital policies, procedures and standards.
Observes at all times legal and ethical considerations pertaining
to patients and hospital personnel. Initiates programs for
improving cost effectiveness in coordination of patient care.
Assists managers to create a participative environment in
department based meetings and other activities. Analyzes and
develops systems to improve processes and outcomes in collaboration
with managers.* Facilitates effective coordination of
interdisciplinary unit/physician team (e.g., Firm on the Medical
Service) rounds to identify the patients clinical management needs,
progression of care, identification of barriers, appropriate
discharge plan and anticipated discharge date. Assumes a leadership
role to coordinate and facilitate daily interdisciplinary
unit/physician team rounds, LOS management and discharge process.
Collaborates with the interdisciplinary team to maintain
appropriate levels of care to expedite the movement of the patient
to alternate levels of care throughout the continuum. Reviews,
monitors and individualizes on an ongoing basis, each patients plan
of care based on diagnosis and assessment of patient/family needs.
Identifies internal obstacles to efficiency and good patient
outcomes and intervenes with healthcare team to eliminate when
possible. Identifies a follow-up time frame to accomplish the
recommended plan. Communicates patient status and needs to the next
level of care for discharge planning.* Facilitates timely and
appropriate communication among attending physicians, nurse
practitioners, physician assistants, patients, family members,
other members of the health care team, external providers and
payers. Refers significant clinical issues per protocol to the
attending physician and/or hospitalist or to the designated
consultants. Utilizes chief of service/physician advisor to address
unresolved clinical and interdisciplinary issues. Participates and
contributes as a regular member of interdisciplinary rounds to
communicate and receive pertinent information. Utilizes critical
thinking skills and assists others to identify and resolve
potential and existing problems related to coordination of patient
care. Determines the best method to communicate with the
interdisciplinary team about different kinds of issues (i.e.,
direct contact, telephoning, emailing, and paging). Collaborates
with attending physician/hospitalist regarding patients achievement
of therapeutic regimen.* Ensures identification of variances and
the development of appropriate contingency plans for each phase of
care in the event of patient health complications or systems
barriers. Communicates with the attending physician/hospitalist,
patient/family and staff regarding alteration in plan. Monitors
test results, patient responses to interventions, health status and
makes recommendations for revisions to treatment plan based on
patient need and responses. Evaluates and communicates changes in
patients clinical condition timely. Documents medical plan of care
and reflects patients progress in meeting prescribed plan.*
Effectively communicates information relative to a potential denial
to the appropriate members of the health care team. Communicates
timely, complete, and accurate information relative to a potential
denial to the appropriate members of the health care team.
Demonstrates an understanding of the peer-to-peer appeal process
for authorization of acute inpatient hospitalization. Effectively
monitors, documents and informs members of the health care team the
outcome of the peer-to-peer appeal process. Demonstrates an
understanding of CMS, Milliman Care Guidelines relative to the
patients diagnosis and condition when providing a clinical review
to the payor to prevent a potential denial. Effectively
communicates the impact on reimbursement to the hospital for
potentially denied days to the health care team. Utilizes the chief
of service/physician advisor per departmental guidelines.*
Coordinates discharge appeals or issuance of Hospital Notices in
accordance with State and Federal Regulations and departmental
guidelines. Demonstrates an understanding of the CMS and NY State
regulations for discharge appeals and issuance of Hospital Notices.
Follows procedures for issuing Hospital Notices when appropriate
and communicate necessary information to healthcare team relative
to patients benefits. Facilitates issuance of the Important Message
from Medicare within 24 48 hours before discharge and the Detailed
Notice of Discharge if indicated. Effectively communicates the
initiation of a discharge appeal to the health care team.
Coordinates the collection of medical record documentation for
review by the review agent (i.e., IPRO, managed care carrier).
Communicates outcome of discharge appeal to patient/family and
health care team.* Communicates the outcome of chart review and
managed care company telephonic review with the health care team as
appropriate. Conducts accurate reviews using CMS, Milliman Care
Guidelines and the patients chart as the primary source of
information. Performs and documents initial certification and
continued stay reviews within appropriate time frame and in
appropriate system. Documents obtained payor authorization in a
complete, timely and concise manner. Maintains follow-up
communication with payor as required for authorization of hospital
stay. Notifies health care team of outcomes of communication with
payor and authorization status. Notifies departmental manager of
all unresolved utilization problems/issues.* Acts as
advocate/facilitator in all cases with insurance related issues,
delays in treatments and/or diagnostic tests. Collaborates with the
interdisciplinary team to maintain appropriate levels of care to
facilitate movement of the patient through the continuum.
Identifies and documents delays in treatment and processes.
Understands basic reimbursement systems and identifies potential
payor issues relative to delays in treatments and/or diagnostic
tests. Assists in developing strategies to decrease avoidable days.
Demonstrates and communicates the value of avoidable days and/or
additional documentation to justify acute inpatient
hospitalization.* Participates in departmental, interdisciplinary,
hospital and Medical Board committees as appropriate. Participates
in departmental, interdisciplinary, hospital and Medical Board
committees as requested. Represents the voice of Care Management in
committee participation. Completes committee assignments as
requested. Provides feedback and periodic reports to Care
Management at departmental meetings and senior managers on relevant
issues.* Educates nursing, medical and ancillary staff about care
management role, relevant clinical criteria and resources available
for patients, as well as regulatory and managed care requirements.
Demonstrates an understanding of the vision and goals of the care
management program. Demonstrates an understanding of the core
functions of the care management role. Demonstrates an
understanding of and effectively communicates information relative
to clinical criteria and resources available for patients/families
to the healthcare team. Serves as a resource for other members of
the health care team by participating in or conducting
formal/informal in-service education as needed. Identifies own
practice abilities and limitations and obtains instruction and
supervision as necessary. This includes seeking education for self
development.* Facilitates patient/family knowledge of and
participation in the plan of care. Identifies long and short term
needs based on a comprehensive assessment and anticipate outcomes.
Proactively identifies hospital services and available resources to
meet the patients needs. Ensures that patients individualized plan
of care is collaborative and multidisciplinary by working with
patient, physician, and health care team members. Focuses the care
plan on quality of life, effective utilization of resources, and
facilitates goal achievement and movement through the continuum of
care. Collaborates with patient/family, physician, and health care
team for final agreement with treatment goals, timeframes and
coordination of care. Develops additional and contingency plan
options with patient/family when planning for discharge.* Serves as
resource for education of patients, families, peers, staff and
physicians. Facilitates patient/family teaching as soon as learning
needs are identified. Provides patient/family education regarding
post acute services, community resources or other as needs
identified. Role models expert professional care management
practices. Supports a constructive environment of learning and
development of mutual respect with health care team and peers.
Facilitates staff access to outside educational opportunities
through sharing of program announcements, etc.* Participates in
development and implementation of appropriate patient/family
education material pertinent to population served. Contributes to
the development of patient/family education material for disease
management. Facilitates patient/family education and understanding
to prevent risk behaviors and to promote and achieve good health
outcomes. Educates the patient/family and provide support in moving
toward self-care. Educates and assists in facilitating
patient/family access to necessary and appropriate health care
services.* Maintains current clinical knowledge in area of review
and patient population. Achieves and maintains current professional
licensure, national certification, and/or higher education in case
management or in a health and human services profession directly
related to case management practice. Maintains continuing
competence appropriate to case management and to professional
licensure or professional certification. Provides only case
management services within scope of practice. Refers patient to
another source for services outside scope of practice. Maintains
continuing competence appropriate to case management and to
professional licensure or professional certification. Maintains
annual mandatory education requirements. Maintains membership in
professional organizations.* Promotes own professional growth and
development in care management role. Identifies own practice
abilities and limitations and obtains instruction and supervision
as necessary. This includes seeking education for self development.
Participates in and utilizes peer review to identify areas for
improvement in practice and leadership. Achieves previously
established personal professional goals. Participates in
departmental education sessions.* Evaluates appropriateness of
alternate level of care for optimal delivery of services to the
patient and for resource efficiency. Assesses the need for
continued acute care services. Anticipates barriers to discharge.
Assesses and re-assesses appropriate discharge plans and options
based on clinical need and patient/family resources. Collaborates
with other members of the interdisciplinary team to dual plan
discharge options. Facilitates patient/family team meetings to
discuss discharge plan and options.* Communicates information
documented in the medical record that identifies a potential
event/occurrence to the Risk Manager. Identifies quality and risk
management issues; refer issues for corrective action as
appropriate. Documents a potential event/occurrence and
communications to the Risk Manager into Canopy within established
timeframes.* Contributes to the development of new strategies to
address transitional planning needs of specific assigned patient
populations, improved care coordination and care management
delivery. Utilizes current literature to facilitate clinical/care
management practice changes. Participates in the development and
revision of clinical/care management practice standards. Engages in
strategies to measure improvements in quality of care that directly
result from care management interventions. Utilizes evaluative and
outcomes data to improve care management services.* Participates in
development of quality indicators and analysis of such indicators
per departmental quality & performance improvement plan.
Collaborates with members of the interdisciplinary team to develop
quality indicators to measure performance improvement per
departmental quality & performance improvement plan. Conducts
required and initiated monitoring activities report to respective
disciplines as indicated. Evaluates outcomes of monitoring, and
adjusts targets and reporting as indicated. Facilitates and ensures
sharing of data and outcomes with interdisciplinary team.* Uses
evidence-based practice to drive improvement strategies. Promotes
health care outcomes in conjunction with evidence-based guidelines.
Identifies areas requiring further study. Develops strategies to
utilize data findings for individual patients as well as program.
Recommends interdisciplinary evidence-based practice changes.*
Identifies cases that require peer review in accordance with the
clinical indicators and criteria developed by the clinical
department. Identifies trends in care, processes or services that
may provide opportunities for improvement in a patient population
or clinical service. Refers appropriately cases that require peer
review in accordance with the clinical indicators and criteria
developed by the clinical department. Takes initiative to
participate in a quality/process improvement initiative.
Collaborates with the interdisciplinary team to create solutions
and take corrective actions to address issues resulting in
variances in the plan of care.Minimum Qualifications:To qualify you
must have a Professional Registered Nurse in New York State with
current registration.Education: BSN required, or graduate of an
accredited RN program with BS in related health care
field.Experience: Three to five years clinical experience, acute
medical-surgical preferred, or in the care of the population to be
care-managed. Competencies: Evidence of excellent interpersonal
skills, effective communication, negotiation and conflict
management skills; creative problem solving and clinical
leadership; change management, organizational and time management
skills. Ability to apply critical thinking and clinical expertise
toward achievement of specific outcomes. Previously demonstrated
ability to foster strong collaboration with co-workers, peers,
physicians, nursing, and ancillary departmental support staff.
Knowledge of Microsoft Office and demonstrated proficiency in
managing software such as Eclipsys Sunrise Manager, Canopy, and
ECIN. Required Licenses: Registered Nurse License-NYSQualified
candidates must be able to effectively communicate with all levels
of the organization.NYU Langone Health 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 Health 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 Health'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 , Care Manager, Registered Nurse, ED/Obs (Night Shift), Healthcare , New York, New York
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