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Stony Brook

    Administrative Manager of Operations - Stony Brook, United States - Stony Brook Medicine

    Stony Brook Medicine
    Stony Brook Medicine Stony Brook, United States

    3 days ago

    Default job background
    Description
    REQUIRED EDUCATION /


    EXPERIENCE:
    RN with Bachelor's degree in Nursing and two years of inpatient experience in a hospital environment. Current license or valid permit to practice professional nursing in Texas.


    JOB DESCRIPTION:


    To support the physician and interdisciplinary team in the provision of patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers.

    The role integrates and coordinates utilization management, care coordination and discharge planning functions.


    ESSENTIAL JOB FUNCTIONS:
    Utilization Management
    Ensure clear admit status and timely management of observation patients
    Demonstrates knowledge of CMS guidelines and use of Local Coverage Determination (LCD) or inpatient and observation, CMS inpatient only list, and other payor guidelines as required
    Demonstrates thorough knowledge in the application of InterQual criteria; Severity of illness (SI), Intensity of service (IS), Discharge screens (DS) SI, IS, and performs continued stay reviews for Medicare, Medicaid and self pay patients
    Demonstrates skill in accurately entering required UM data. Works closely with denials/appeals coordinator
    Elevate to department leadership all patients not meeting medical necessity criteria after impasse with attending physician
    Creates final patient discharge disposition (closing of cases)


    Level of Care:
    Ensure appropriate level of care/patient status
    Facilitate clinical care progression of patient by multidisciplinary team throughout stay
    Demonstrates knowledge of CMS guidelines and use of LCD for inpatient and observation, CMS inpatient only list, and other payor guidelines as required
    Demonstrates appropriate application of InterQual LOC criteria to evaluate current patient care needs.
    Elevate to department leadership all patients in an inappropriate level of care after impasse with attending physician
    Documents avoidable days
    Assessment of patients' financial, emotional, physical, social, functional and health care needs
    Demonstrates ability to assess discharge needs of all patients, and ability to prioritize patients by need, e.g. Medicare, high risk diagnoses, high risk for readmission, identified vulnerable patients
    Identify readmission risk and target interventions to reduce risk for readmission
    Define and recommend potential discharge plan
    Utilize assessment to begin management of patient and family expectations regarding the plan of care

    Care Coordination of Treatment Plan:
    Medical and Multidisciplinary
    Participate in multidisciplinary rounds. Facilitates clinical care progression of multidisciplinary team in a timely and efficient manner
    Facilitate Patient Care conferences based on patient/family needs
    Manage patient and family expectations the plan of care
    Contact appropriate ancillary department with any delays impacting care progression
    Address incomplete, unclear medical plan of care with attending physician. If unsuccessful, elevate to department leadership, director or physician advisor as appropriate.


    Salary:
    Salary commensurate with experience

    Equal Employment Opportunity


    UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law.

    As a VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.

    #J-18808-Ljbffr

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