- & & & & & & & & & & & BSN or related Bachelor's degree required
- & & & & & & & & & & & 5 years clinical ED, critical care or med/surg experience required
- & & & & & & & & & & & Previous case management experience REQUIRED
- & & & & & & & & & & & Knowledge of healthcare financial, regulatory, and payer issues preferred
- & & & & & & & & & & & Knowledge of state, local, and federal programs strongly preferred
- & & & & & & & & & & & Experience in use of Milliman/InterQual criteria
- & & & & & & & & & & & Registered Nurse (RN) NYS license required
- & & & & & & & & & & & PRI/Screen certification strongly preferred.
- & & & & & & & & & & & C.C.M. (Certified Case Manager) certification REQUIRED
- & & & & & & & & & & & Computer skills essential
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Hackensack Meridian Health Hackensack, United States Full timeOverview: · Our team members are the heart of what makes us better. At Hackensack Meridian _Health_ we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, ...
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Care Management Coordinator,
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Northwell Health Manhasset, United StatesRaise your career expectations as a care management coordinator at Northwell Health: · - Named Fair360's Top Hospital and Health System for workplace fairness, equity and inclusion. · - New York State's largest private employer and healthcare provider. · **Location**: · Health So ...
RN Care Manager 80002 - White Plains, United States - Cephas Consultancy Services Private Limited
Description
Job Description
Job DescriptionFull Time | Day | M-F 9A-5P with a weekend rotation ( Sat Sun)Sign On Bonus :
$5,000Position Summary& & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & The RN Care Manager performs the initial comprehensive assessment on admission in accordance with the Care Management Department policy, screening all patients by utilizing established tools for high risk indicators (i.e. AIMS, Geisinger, polypharmacy) to ensure high risk patient populations receive the appropriate supportive services for discharge to prevent readmission and assess all populations for potential discharge planning needs. Provides ongoing reassessment of needs throughout the hospital course. Performs UR activity per department policy.
& Essential Functions and Responsibilities Includes the Following:
& & & & & & & & & & & & & & & & & & & & & & & & & & & & & 1.& & & & & & & & & Understands and adheres to our Performance Standards, Policies and Behaviors2.& & & & & & & & & Completes a comprehensive initial assessment.3.& & & & & & & & & Performs all activities for multidisciplinary care coordination at the intra-hospital level of care and inter-hospital level of care.4.
& & & & & & & & & Performs all transitional planning activities including but not limited to:
o& & & & & & & & & & Patient/caregiver educationo& & & & & & & & & & Arrangement of all aftercareo& & & & & & & & & & Commercial payer involvemento& & & & & & & & & & High utilizer patient root cause5.& & & & & & & & & Communicates and collaborates all relevant patient information to appropriate health team members.6.& & & & & & & & & Ensures department goals of LOS reduction, readmission prevention, denial reduction, and satisfaction improvement are realized.7.& & & & & & & & & Documents per department requirements.8.& & & & & & & & & Participates in Performance Improvement activities as needed.9.
& & & & & & & & & Performs all UR activities per department policy:o& & & & & & & & & & Commercial payer reviewso& & & & & & & & & & Disposition determination,o& & & & & & & & & & Retro/self-audito& & & & & & & & & & MC varianceo& & & & & & & & & & Admission clinical review.10.
& & & & & & & Performs all other related duties as assigned& Education Experience Requirements& & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & &
