Description
The Case Manager is responsible for all aspects of discharge planning and utilization management/review for an assigned group of patients to determine the appropriateness of the admission and continued stay, assist in the development of the plan of care; ensure that the plan is implemented timely and identify the expected length of stay (ELOS). The Case Manager works collaboratively with physicians, social workers, clinical nurses, home care services, and other members of the interdisciplinary team. The Case Manager actively participates in specific clinical initiatives focused on reducing the length of stay (LOS), improving efficiency and quality, and ensuring resource utilization is appropriate.
Case manager/utilization manager: Responsible for an average of 60-70 medical/surgical daily admissions that requires risk identification and clinical reviews. A utilization nurse completes no less than 20 initial clinical reviews daily. Responsibilities also includes: Completing 100% clinical reviews for managed care, Medicare and Medicaid admissions
Completing concurrent and retrospective reviews
Communicating with physicians and the inpatient case management teams on patients who do not meet initial inpatient criteria or continued inpatient stay
Coordinating expedited appeals for inpatient denials with attending physicians and insurance providers
Ensuring organization resources are being utilized appropriately
Completing patient assessments within 24 hours
Coordinating safe and appropriate post-acute care plans
Obtains authorizations from managed care companies for post-discharge services.There is an onsite home care agency and a transfer and authorization center that can facilitate the referral process.This is a full time Monday Friday position 8:30am -5:00pmPosition requires weekend rotation and volunteer for holidays
Preferred Criteria
- Master s degree
- CCM certification
Required Criteria
- Current NYS RN license
- Bachelor s degree in Nursing (BSN)
- 3-5 yrs Acute Care RN nursing experience
- Previous experience in inpatient acute care case manager/discharge planning, certified home health care (CHHA), Case Management experience, utilization experience, or managed care organization experience required
- PRI certification within one year of hire.
- Ability to work independently and collaboratively within an interdisciplinary team
Join a healthcare system where employee engagement is at an all-time high. Here we foster a culture of respect, diversity, and inclusion. Enjoy comprehensive and competitive benefits that support you and your family in every aspect of life. Start your life-changing journey today.
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- 2021 ” Best Workplaces in Health Care & Biopharma” –Fortune
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- 2020 “Best Companies for Multicultural Women” –Working Mother
- 2020 “Best Workplace for Men in Nursing” –American Association for Men in Nursing
- Discover why at:nyp.org/careers
NewYork-Presbyterian Hospital is an equal opportunity employer.
Salary Range:
$50.87-$56.48/Hourly
It all begins with you. Our amazing compensation packages start with competitive base pay and include recognition for your experience, education, and licensure. Then we add our amazing benefits, countlessopportunities for personal and professional growth and a dynamic environment that embraces every person. Join our team and discover where amazing works.
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Associated topics: bsn, cardiothoracic, care unit, domiciliary, intensive care, maternal, mhb, recovery, registered nurse, surgery
