Northwell Health Case Manager in Forest Hills, New York

Req Number 001RH5

Job Category Quality Management

Job Description

Facilitates patient's hospitalization from pre-admission through post-discharge. Coordinates with physicians, nurses, social workers and other health team members to expedite medically appropriate, cost-effective care. Assesses, plans, oversees and evaluates the appropriateness of care across the acute care continuum. Applies clinical expertise and medical appropriateness criteria to resource utilization and discharge planning.

Responsibilities Include:

  1. Coordinates and facilitates patient care throughout hospitalization.

• Performs a case management intake assessment.

• Orients patient to the role of the case manager, the goals of care and expected length of stay.

• Discusses with attending physician and/or physician advisor the appropriateness of resource utilization, consultation and treatment plan.

• Participates in interdisciplinary patient care rounds.

• Discusses estimated length of stay, treatment and discharge plan with the attending physician, as indicated.

• Identifies and assists in removing barriers to patient care (variances) and resolves issues with appropriate departments and staff.

• Coordinates and facilitates transitional planning needs through the acute care continuum.

• Makes referrals to social work as identified through the high risk screening process using high-risk criteria,.

• Consults with the physician regarding physical therapy, nutrition, speech therapy, respiratory therapy and other ancillary services as needed.

• Collaborates with members of the interdisciplinary team to assess, plan, implement, coordinate and monitor services required to achieve quality patient care and resource management.

• Serves as liaison between patients, families, physicians, payers and other members of the interdisciplinary care team.

  1. Coordinates and facilitates the discharge planning process.

• Initiates discharge planning by assessing the patient's needs and documenting the assessment on the interdisciplinary care team.

• Works collaboratively with the physician and interdisciplinary team to determine the patient's need for continuing care services.

• Ensures interdisciplinary care plan and discharge plan are consistent with the patient's clinical course, continuing care needs and covered services.

• Conducts a case management assessment including the patient's physical, psychosocial and financial needs and issues.

• Interviews patient or designated agent to assess discharge-planning needs.

• Involves patient and/or family in discussion and planning for anticipated need for care following discharge.

• Ensures discharge plan is safe and timely.

• Completes paperwork and/or ensures paperwork is completed and distributed.

• Ensures patient and/or family are given information regarding their choices regarding transfer to another level of care according to regulatory standards.

• Ensures continuing care services including transportation, durable medical equipment, etc. are appropriately arranged for and financially approved.

  1. Performs concurrent utilization management.

• Reviews appropriateness of patient's admission, need for continued stay and discharge criteria using established criteria.

• Discusses with attending physician and/or physician advisor the appropriateness of resource utilization, consultation and treatment plan.

• Ensures patient meets acute care criteria during each in-patient day.

• Places patient on alternate level of care (ALC) status In concert with attending physician.

• Responds to third party payer requests for concurrent clinical information providing all relevant documentation to ensure reimbursement within expected time frames.

• Disseminates documents of non-coverage when appropriate.

• Ensures compliance with current state, federal and third party payer regulations.

• Works collaboratively with on-site reviewers to transition patients to appropriate discharge settings.

  1. Participates in quality management of patient care outcomes.

• Identifies and collects quality data including pre-established quality screens, NYPORTS and core measures.

• Identifies and reports quality issues to the department management.

• Ensures minimum quality standards are met each day of hospitalization.

  1. Documents case management process in the medical record.

• Documents on-going process of discharge planning including discharge assessment, plan and on-going evaluation and up-dates.

• Provides summary note at time of discharge synthesizing the discharge plan and follow-up care needs.

• Completes appropriate portions of Patient Discharge Instruction Sheet.

• Completes and facilitates completion of the Patient Review Instruments (PRI) with other disciplines.

• Completes case management intake assessment form.

• Completes relevant documents including Patient Transfer Form.

• Documents on-going case management progress notes in the medical record.

  1. Performs related duties, as required.

Qualifications

• Bachelors Degree in Nursing, required. Masters Degree, preferred.

• Current license to practice as a Registered Professional Nurse in New York State.

• Patient Review Instruments (PRI) Certification, preferred.

• Certification in Case Management, preferred.

• Minimum five (5) years clinical experience as a registered nurse. Prior experience in utilization management and/or discharge planning, preferred.

• A strong clinical background and an understanding of the preparation and post procedure monitoring requirements for diagnostic/radiological and/or surgical procedures.

• PC literate. Knowledge of Microsoft Office, Excel, spreadsheet management required.