DUTIES: The Case Manager will report to the Supervisor of Case Management and provide critical assistance in discharge planning activities as well as provide clinical reviews to manage care payers and the medical team as appropriate. Complete initial clinical reviews daily and timely on all Managed Care patients. Perform initial/concurrent reviews using standard review criteria via (Milliman Care Guidelines) to determine medical necessity. Facilitate discharge planning and collaborate with social workers on appropriate teams. Attend and participate in daily team conferences. Communicate with multidisciplinary teams to ensure proper documentation that will enhance maximum reimbursement. Ensure appropriate documents that meet regulatory requirements are in the medical record eg: IMM forms, Observation notices. Ensure patients are placed in the proper level of care by communicating with the approriate physicians. Communicate with patient/family members appropriately and be cognizant of cultural facts that can affect hospital stay and discharge planning. Document delays or variances from expected length of stay in Morissey. Identify patients who are re-admitted within 30 days. Assess for actual/potential risks then confer concerns to medical team and appropriate social worker. Document interaction in patients' medical records. Facilitate the peer-peer process with physicians for denied cases. (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. Additional Info: Hours of work : 9AM-5PM; Days of the week: Mon-Fri; Hours per week: 22.5. THIS IS A PART-TIME POSITION @ .60 FTE.Closing Date: Open Until Filled STATE UNIVERSITY OF NEW YORK IS AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER
Internal Number: 56529
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.