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Case Manager

Bachelors Degree in Nursing, required. Masters Degree, preferred. o Current license to practice as a Registered Professional Nurse in New York State. o Patient Review Instruments (PRI) Certification, preferred. o Certification in Case Management, preferred. o Minimum five (5) years clinical experience as a registered nurse. Prior experience in utilization management and/or discharge planning, preferred. o A strong clinical background and an understanding of the preparation and post procedure monitoring requirements for diagnostic/radiological and/or surgical procedures. o PC literate. Knowledge of Microsoft Office, Excel, spreadsheet management required. o Serves as liaison between patients, families, physicians, payers and other members of the interdisciplinary care team. 2. Coordinates and facilitates the discharge planning process. o Initiates discharge planning by assessing the patient's needs and documenting the assessment on the interdisciplinary care team. o Works collaboratively with the physician and interdisciplinary team to determine the patient's need for continuing care services. o Ensures interdisciplinary care plan and discharge plan are consistent with the patient's clinical course, continuing care needs and covered services. o Conducts a case management assessment including the patient's physical, psychosocial and financial needs and issues. o Interviews patient or designated agent to assess discharge-planning needs. o Involves patient and/or family in discussion and planning for anticipated need for care following discharge. o Ensures discharge plan is safe and timely. o Completes paperwork and/or ensures paperwork is completed and distributed. o Ensures patient and/or family are given information regarding their choices regarding transfer to another level of care according to regulatory standards. o Ensures continuing care services including transportation, durable medical equipment, etc. are appropriately arranged for and financially approved. 3. Performs concurrent utilization management. o Reviews appropriateness of patient's admission, need for continued stay and discharge criteria using established criteria. o Discusses with attending physician and/or physician advisor the appropriateness of resource utilization, consultation and treatment plan. o Ensures patient meets acute care criteria during each in-patient day. o Places patient on alternate level of care (ALC) status In concert with attending physician. o Responds to third party payer requests for concurrent clinical information providing all relevant documentation to ensure reimbursement within expected time frames. o Disseminates documents of non-coverage when appropriate. o Ensures compliance with current state, federal and third party payer regulations. o Works collaboratively with on-site reviewers to transition patients to appropriate discharge settings. 4. Participates in quality management of patient care outcomes. o Identifies and collects quality data including pre-established quality screens, NYPORTS and core measures. o Identifies and reports quality issues to the department management. o Ensures minimum quality standards are met each day of hospitalization. 5. Documents case management process in the medical record. o Documents on-going process of discharge planning including discharge assessment, plan and on-going evaluation and up-dates. o Provides summary note at time of discharge synthesizing the discharge plan and follow-up care needs. o Completes appropriate portions of Patient Discharge Instruction Sheet. o Completes and facilitates completion of the Patient Review Instruments (PRI) with other disciplines. o Completes case management intake assessment form. o Completes relevant documents including Patient Transfer Form. o Documents on-going case management progress notes in the medical record. 6. Performs related duties, as required. 001ZRG
Salary Range: NA
Minimum Qualification
5 - 7 years

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