Case Manager Family Health Centers Brooklyn at NYU Langone Health in New York, NY
Job
Responsibilities:
Provide care coordination for patients including patient navigation, chronic disease management/education and interdisciplinary collaboration while complying with department and agency policies and procedures and other contractual requirements. Monitor remote patient monitoring tools and notify interdisciplinary team when follow-up is required to address out of range results. Work with patient and care team to conduct assessments that result in a comprehensive care plan that contains goals prioritized by the patient and/or provider. Track overtime goal outcomes, interventions, and continue to reassess the patient's needs as appropriate. Establish appropriate timeframe for frequency of follow-up activities and provide closure and referral services as patient move through and complete programming. Engage patients in taking a proactive role for managing their health, medications, treatment and rehabilitation needs, and follow-up appointments and refer patients to the appropriate community based, health plan or other programs. Interact with relevant providers stakeholders and collaborate with relevant staff to support regular interactions with program. Follow evidence based guidelines and contact standards to facilitate closure of gaps in care and encourage and use of in network services. Use the Epic electronic medical record to conduct care coordination activities and comply with associated policies and procedures including those for work flow and consistent documentation. Participate in team based support and contribute to ongoing program design and development as lessons are learned from the field and process improvement work in performed within in the department. Initiate/maintain professional development plan including goals for self-improvement and to sustain clinical and NYULMC competencies; attend and participate in program/initiative teleconferences, program enhancement trainings and meetings, as required. Meet all other expectations and responsibilities of the program/initiative agreement as related to care coordination. Work in an ever evolving environment that can include telemedicine, phone based support, and in-person care in clinics, in the field and the community. Facilitates physician discussion with medical director of third party payer in an attempt to overturn potential denial. Assists in the appeal process (concurrently and retrospectively) for appeal of days and procedures. Documents clinical reviews in Allscripts, and forwards same to appropriate payer as necessary. Communicates salient clinical parameters through chart abstraction Facilitates clinical managed care reviews to avoid technical denials Collaborates with the physicians and interdisciplinary care team regarding expected LOS for specific patients utilizing MCG criteria and Medicare benchmarks. Ensures that the team is actively working towards transition to the next level of care and identified expected discharge date. Prevents length of stay delays by recognizing when the acute level of care is no longer necessary and continued ongoing testing/treatment can be rendered on an outpatient basis, working with the clinical staff to ensure that such services are scheduled and approval obtained to facilitate the appropriate discharge and follow up. Facilitates efficient care processes and follows through on delays in work-up, treatment and/ or discharge. Expedites testing/procedures to prevent avoidable delays and facilitate movement towards next level of care. Refers potentially avoidable days to physician advisor when appropriate Discusses medical necessity, as identified by the use of clinical criteria, with the interdisciplinary team to facilitate timely movement to the next level of care Assesses appropriateness of patient's admission, need for continued stay, level of inpatient care and discharge level of care Acts as a resource to physicians/ staff regarding MCG criteria for top DRG's on CM's unit Coordinates post discharge appointments with PCP to ensure cross continuum continuity of care. Communicates promptly and effectively with responsible medical, nursing and ancillary staff to ensure documentation adequately reflects patient clinical status, admission status and need for continued stay. Monitors patient progress toward goals Provides informal education for hospital personnel that enhance their knowledge regarding clinical pathways, reimbursement issues, federal/state regulations, discharge planning issues and early recognition of post-hospital needs. Encourages and facilitates high level of collaboration with medical staff, interdisciplinary team, and agencies contracted to provide continuing care services. vNY State RN license BSN required. At least five years relevant clinical experience with demonstrated leadership skills required. Masters Degree in Nursing preferred Case Management certification preferred. PRI certification preferred Experience in Quality Improvement, Utilization Management, Case Management preferred. Microsoft Office skills required, database/spreadsheet skills preferred. Ability to learn computer programs as needed. Willingness to devote the time required completing assigned tasks on schedule. . Qualified candidates must be able to effectively communicate with all levels of the organization. NYU Langone Hospital - Brooklyn provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.
Salary Range:
$100K -- $150K
Minimum Qualification
Nursing, Healthcare ManagementEstimated Salary: $20 to $28 per hour based on qualifications.
Responsibilities:
Provide care coordination for patients including patient navigation, chronic disease management/education and interdisciplinary collaboration while complying with department and agency policies and procedures and other contractual requirements. Monitor remote patient monitoring tools and notify interdisciplinary team when follow-up is required to address out of range results. Work with patient and care team to conduct assessments that result in a comprehensive care plan that contains goals prioritized by the patient and/or provider. Track overtime goal outcomes, interventions, and continue to reassess the patient's needs as appropriate. Establish appropriate timeframe for frequency of follow-up activities and provide closure and referral services as patient move through and complete programming. Engage patients in taking a proactive role for managing their health, medications, treatment and rehabilitation needs, and follow-up appointments and refer patients to the appropriate community based, health plan or other programs. Interact with relevant providers stakeholders and collaborate with relevant staff to support regular interactions with program. Follow evidence based guidelines and contact standards to facilitate closure of gaps in care and encourage and use of in network services. Use the Epic electronic medical record to conduct care coordination activities and comply with associated policies and procedures including those for work flow and consistent documentation. Participate in team based support and contribute to ongoing program design and development as lessons are learned from the field and process improvement work in performed within in the department. Initiate/maintain professional development plan including goals for self-improvement and to sustain clinical and NYULMC competencies; attend and participate in program/initiative teleconferences, program enhancement trainings and meetings, as required. Meet all other expectations and responsibilities of the program/initiative agreement as related to care coordination. Work in an ever evolving environment that can include telemedicine, phone based support, and in-person care in clinics, in the field and the community. Facilitates physician discussion with medical director of third party payer in an attempt to overturn potential denial. Assists in the appeal process (concurrently and retrospectively) for appeal of days and procedures. Documents clinical reviews in Allscripts, and forwards same to appropriate payer as necessary. Communicates salient clinical parameters through chart abstraction Facilitates clinical managed care reviews to avoid technical denials Collaborates with the physicians and interdisciplinary care team regarding expected LOS for specific patients utilizing MCG criteria and Medicare benchmarks. Ensures that the team is actively working towards transition to the next level of care and identified expected discharge date. Prevents length of stay delays by recognizing when the acute level of care is no longer necessary and continued ongoing testing/treatment can be rendered on an outpatient basis, working with the clinical staff to ensure that such services are scheduled and approval obtained to facilitate the appropriate discharge and follow up. Facilitates efficient care processes and follows through on delays in work-up, treatment and/ or discharge. Expedites testing/procedures to prevent avoidable delays and facilitate movement towards next level of care. Refers potentially avoidable days to physician advisor when appropriate Discusses medical necessity, as identified by the use of clinical criteria, with the interdisciplinary team to facilitate timely movement to the next level of care Assesses appropriateness of patient's admission, need for continued stay, level of inpatient care and discharge level of care Acts as a resource to physicians/ staff regarding MCG criteria for top DRG's on CM's unit Coordinates post discharge appointments with PCP to ensure cross continuum continuity of care. Communicates promptly and effectively with responsible medical, nursing and ancillary staff to ensure documentation adequately reflects patient clinical status, admission status and need for continued stay. Monitors patient progress toward goals Provides informal education for hospital personnel that enhance their knowledge regarding clinical pathways, reimbursement issues, federal/state regulations, discharge planning issues and early recognition of post-hospital needs. Encourages and facilitates high level of collaboration with medical staff, interdisciplinary team, and agencies contracted to provide continuing care services. vNY State RN license BSN required. At least five years relevant clinical experience with demonstrated leadership skills required. Masters Degree in Nursing preferred Case Management certification preferred. PRI certification preferred Experience in Quality Improvement, Utilization Management, Case Management preferred. Microsoft Office skills required, database/spreadsheet skills preferred. Ability to learn computer programs as needed. Willingness to devote the time required completing assigned tasks on schedule. . Qualified candidates must be able to effectively communicate with all levels of the organization. NYU Langone Hospital - Brooklyn provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.
Salary Range:
$100K -- $150K
Minimum Qualification
Nursing, Healthcare ManagementEstimated Salary: $20 to $28 per hour based on qualifications.
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