Case Manager Rn-mount Sinai West- Full Time- Days - New York, United States - Mount Sinai

Mount Sinai

Verified Company

New York, United States

4 weeks ago

Posted by:

Mark Lane

beBee recruiter

Full time

Description

Description

The Case Manager is responsible for all aspects of case management/ utilization review for an assigned group of inpatients, ED patients and Observation ( RETU) patients to determine the correct Level of care ( LOC), appropriateness of the admission and continued stay, assist in the development of the plan of care; ensure that the plan is implemented in a timely basis 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 as needed to develop a plan of care which includes discharge planning, resource management, health education, and the provision of information as it relates to care management and the transition of care.

The Case Manager actively participates in specific clinical initiatives focused on LOC, reducing the length of stay (LOS), improved efficiency and quality and resource utilization.

Assignment will be by units/clinical areas of practice and may require responsibility on other units/services.

Responsible For A group of inpatients 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 in a timely basis, and identify the expected length of stay (ELOS) and problem solves care transitions accordingly within the interdisciplinary health care team.

Responsibilities

Principal Duties and Responsibilities Principle Duties and responsibilities include, but are not limited to:

Review and advice for appropriate level of care using criteria sets (refer to designated site software), cases referred or who have Observation diagnosis, or other high risk diagnosis as well as readmissions.
Review all patients in RETU to insure they meet Observation criteria, assist with discharge or admit to next LOC with-in unit specified timeframes.
Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve optimal patient outcomes and appropriate reimbursement for the organization.
Performs continued stay reviews utilizing standardized criteria to justify continued inpatient stay.
Oversee clinical throughput of patient, ensuring medical treatment plan, e.g., timely tests, consults.
Collaborates with Physicians and other clinicians to expedite diagnostic testing, treatment and consultations.
Documents all clinical reviews in using designated site software program.
Supports the mission, vision, philosophy and goals of the Medical Center.
Promotes an environment that is sensitive to cultural diversity and is open and responsive to the diverse backgrounds and experience of others.
Liaison with Physician Advisor.
2.

Case Management:

Assessment of the patient's clinical, psychosocial, and functional status in collaboration with the interdisciplinary team.
Identification and documentation of variances affecting the LOS and the discharge planning process.
Conducts follow-up of any delays in treatment or reporting of results.
Planning/developing specific goals with the physician, interdisciplinary team, and the patient and/or family.
Implementation and coordination of specific activities, strategies, and interventions to move the patient through the continuum of care.
Determine ALC status and track avoidable days.
Documentation of outcomes achieved and identified internal and external barriers.
Identifies reasons for readmissions and collaborates with interdisciplinary team on strategies to reduce readmission rate.
Appropriately identifies and refers cases to the physician advisor to support timely progression of patients along the continuum of care and (appropriate) discharge planning.
Interacts with patient/family to discuss plan of care and coordination of services based on clinical needs and available resources.
3.

Utilization Review:

Maintains a working knowledge of the UR requirements of each payor within the patient population
Provides the clinical information requested by the managed care companies as part of the concurrent review in a timely fashion.
Provides clinical information requested by the managed care companies in accordance with contractual agreements.
Works collaboratively with physicians and managed care companies on concurrent denial appeals
Communicates clinical information to the payor, as needed, coordinating direct communication between physician and payor Medical Director as required.
Performs additional duties as assigned.
4. Discharge Planning Responsible for assessment, communication and monitoring of discharge planning process in collaboration with the clinical nurse initiates the discharge planning process on admission. In collaboration with Social worker, obtains authorizations from managed care companies for postdischarge services. Assesses for clinical rea