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RN Care Manager

2 months ago

White Plains, United States Cephas Consultancy Services Private Limited Full time
Job DescriptionJob DescriptionPer Diem Day 2 shifts per month, 8:30 – 4:30 or 9 am-5 pmSign 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& & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & •& & & & & & & & & & & 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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