CASE MANAGER/Dept.of S0CIAL SERVICES/MEDICAL CARE REVIEW
SUNY Downstate Medical Center
February 1, 2018
Brooklyn, New York
DUTIES: To provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. The overall goal of the Case Manager is to enhance the quality of patient management, facilitate continuity of care and promote cost effectiveness through the integration of case management, utilization management and discharge planning. The Case Manager provides the hospital case management, utilization review and discharge planning to assure that the patient progresses through the continuum of care and is discharged through a well-coordinated transition of care plan. The Case Manager facilitates the provision of patient-focused high quality and cost effective care. The Case Manager uses their expertise to offer alternative means of care in patients that is sensitive to both patient needs and the hospitals budgetary requirements. RESPONSIBILITIES: Utilize standard screening criteria-Milliman Care Guidelines CareWEbQI-to justify level of care, medical necessity, severity of illness and intensity of care. Discuss cases not meeting inpatient admission criteria with physician advisor or attending physician. Complete initial and continued stay clinical review using CareWebvQI to determine medical necessity of continued stay and to identify appropriate alternative levels and site of care. Document daily variance on CareWebQI for cases not meeting guideline day or stage. Enter ELOS (Expected Length of Stay) on patient banner within the EMR after initial clinical review. Participate in daily multidisciplinary huddles in the unit assigned to discuss plan of care and discharge planning needs. Proactively collaborate with Attending Physician, Social Worker and Nursing to develop and carry out appropriate discharge plan. Provide patient/family conferences and education as needed to ensure appropriate Length of Stay (LOS) and transition of care from hospital. Issue HINN (Hospital Issued Notice of Non-Coverage) to Medicare patients. Provide IMM (Important Message from Medicare) form to Medicare patients 48 hours prior to discharge. Facilitate peer to peer review between SUNY UHB physician and the managed care medical director as needed. Complete Patient Review Instrument (PRI) for patients discharged to sub-acute rehab and skilled nursing facility. Take accountability for the Length of Stay (LOS) within assigned unit. Document clearly and concisely all contacts and information of the patient's cases management process in MCCM. (DUTIES AND RESPONSIBILITIES ARE NOT LIMITED TO THE ABOVE POSITION DESCRIPTION) QUALIFICATIONS: REQUIRED: Bachelor's degree in Nursing. Current NYS RN License. PRI and Case Management Certification. EXPERIENCE: Broad Clinical knowledge and experience. Minimum of three (3) years acute hospital and nursing care. Minimum of two (2) years in utilization review and case management. Minimum of one (1) year experience in discharge planning. Knowledge: Federal, State and TJC regulations. Medicare, Medicaid and Managed care standards requirements, reimbursement systems, benefits and benefits administration. Proficiency in use of PC, Microsoft Office Suite and Clinical Applications. Skills: Ability to work with diverse patient populations with knowledge and sensitivity to cultural and spiritual influences impacting on patient care. Possess a positive attitude, motivation and good interpersonal skills. Excellent verbal and written communication skills. Good problem resolution skills. Ability to work in a multidisciplinary-team approach. Ability to work independently with minimal supervision. PREFERRED: Graduate degree in healthcare field. Additional Info: * Represents Location Pay for full-time appointees. Hours of work: 8AM-4PM; Days of week: M-F; Hours per week: 37.5Closing Date: Open Until Filled STATE UNIVERSITY OF NEW YORK IS AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER
Internal Number: 53567
About SUNY Downstate Medical Center
SUNY Downstate's College of Medicine, Health Related Professions, Nursing and its School of Graduate Studies offer students a broad professional education that will prepare them for practice or careers in any location and community. This education provides exceptional opportunities for those students with a commitment to promoting health in urban communities and addressing the complex challenges of investigating and preventing diseases that confront clinicians, educators, and researchers in such an environment. This special aspect of Downstate's unique mission is reflected in the students it attracts and selects, the vast majority of whom are drawn from the New York City Metropolitan area. Many of these students are members of minority and cultural groups underrepresented in the health professions, and/or come from families of first-generation immigrants or from economically disadvantaged backgrounds.