Registered Nurse, Care Manager

NYU Langone Health is a world-class, patient-centered, integrated academic medical center, known for its excellence in clinical care, research, and education. It comprises more than 200 locations throughout the New York area, including five inpatient locations, a children's hospital, three emergency rooms and a level 1 trauma center. Also part of NYU Langone Health is the Laura and Isaac Perlmutter Cancer Center, a National Cancer Institute designated comprehensive cancer center, and NYU Grossman School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. At NYU Langone Health, equity, diversity, and inclusion are fundamental values. We strive to be a place where our exceptionally talented faculty, staff, and students of all identities can thrive. We embrace diversity, inclusion, and individual skills, ideas, and knowledge. For more information, go to , and interact with us on LinkedIn, Glassdoor, Indeed, Facebook, Twitter, YouTube and Instagram.

Position Summary:
We have an exciting opportunity to join our team as a Registered Nurse, Care Manager (RN), Per Diem.

In this role, the successful candidate Coordinates, negotiates, procures, and manages the care of patients by providing focused care coordination across the acute care continuum. Evaluates appropriate clinical resource utilization, and assesses patients for transitioning to the next appropriate level of care through review of patient records and information derived from interdisciplinary rounds. Collaborates with the health care team to ensure the achievement of quality outcomes for patients/families

Job Responsibilities:

• • Assesses patient and medical record documentation for appropriate acute admission and level of care, quality and safety indicators, and plans for discharge. Assesses patient and medical record documentation to identify medical necessity and appropriateness of admission and continued stay using pre-established clinical criteria (i.e., Milliman Care Guidelines, CMS) according to hospital policy. Ensures that the physicians documentation supports level of care. Collaborates with physician when additional documentation needed to support level of care. Communicates appropriate level of care to the health care team. Utilizes patient assessment information to identify quality and safety indicators to monitor during hospital stay. Performs initial and ongoing assessment of patient/family needs for discharge planning and communicates findings to interdisciplinary team.
  • Identifies cases that require peer review in accordance with the clinical indicators and criteria developed by the clinical department. Identifies trends in care, processes or services that may provide opportunities for improvement in a patient population or clinical service. Refers appropriately cases that require peer review in accordance with the clinical indicators and criteria developed by the clinical department. Takes initiative to participate in a quality/process improvement initiative. Collaborates with the interdisciplinary team to create solutions and take corrective actions to address issues resulting in variances in the plan of care.
  • Uses evidence-based practice to drive improvement strategies. Promotes health care outcomes in conjunction with evidence-based guidelines. Identifies areas requiring further study. Develops strategies to utilize data findings for individual patients as well as program. Recommends interdisciplinary evidence-based practice changes.
  • Participates in development of quality indicators and analysis of such indicators per departmental quality & performance improvement plan. Collaborates with members of the interdisciplinary team to develop quality indicators to measure performance improvement per departmental quality & performance improvement plan. Conducts required and initiated monitoring activities report to respective disciplines as indicated. Evaluates outcomes of monitoring, and adjusts targets and reporting as indicated. Facilitates and ensures sharing of data and outcomes with interdisciplinary team.
  • Contributes to the development of new strategies to address transitional planning needs of specific assigned patient populations, improved care coordination and care management delivery. Utilizes current literature to facilitate clinical/care management practice changes. Participates in the development and revision of clinical/care management practice standards. Engages in strategies to measure improvements in quality of care that directly result from care management interventions. Utilizes evaluative and outcomes data to improve care management services.
  • Communicates information documented in the medical record that identifies a potential event/occurrence to the Risk Manager. Identifies quality and risk management issues; refer issues for corrective action as appropriate. Documents a potential event/occurrence and communications to the Risk Manager into Canopy within established timeframes.
  • Evaluates appropriateness of alternate level of care for optimal delivery of services to the patient and for resource efficiency. Assesses the need for continued acute care services. Anticipates barriers to discharge. Assesses and re-assesses appropriate discharge plans and options based on clinical need and patient/family resources. Collaborates with other members of the interdisciplinary team to dual plan discharge options. Facilitates patient/family team meetings to discuss discharge plan and options.
  • Promotes own professional growth and development in care management role. Identifies own practice abilities and limitations and obtains instruction and supervision as necessary. This includes seeking education for self development. Participates in and utilizes peer review to identify areas for improvement in practice and leadership. Achieves previously established personal professional goals. Participates in departmental education sessions.
  • Maintains current clinical knowledge in area of review and patient population. Achieves and maintains current professional licensure, national certification, and/or higher education in case management or in a health and human services profession directly related to case management practice. Maintains continuing competence appropriate to case management and to professional licensure or professional certification. Provides only case management services within scope of practice. Refers patient to another source for services outside scope of practice. Maintains continuing competence appropriate to case management and to professional licensure or professional certification. Maintains annual mandatory education requirements. Maintains membership in professional organizations.
  • Participates in development and implementation of appropriate patient/family education material pertinent to population served. Contributes to the development of patient/family education material for disease management. Facilitates patient/family education and understanding to prevent risk behaviors and to promote and achieve good health outcomes. Educates the patient/family and provide support in moving toward self-care. Educates and assists in facilitating patient/family access to necessary and appropriate health care services.
  • Serves as resource for education of patients, families, peers, staff and physicians. Facilitates patient/family teaching as soon as learning needs are identified. Provides patient/family education regarding post acute services, community resources or other as needs identified. Role models expert professional care management practices. Supports a constructive environment of learning and development of mutual respect with health care team and peers. Facilitates staff access to outside educational opportunities through sharing of program announcements, etc.
  • Facilitates patient/family knowledge of and participation in the plan of care. Identifies long and short term needs based on a comprehensive assessment and anticipate outcomes. Proactively identifies hospital services and available resources to meet the patients needs. Ensures that patients individualized plan of care is collaborative and multidisciplinary by working with patient, physician, and health care team members. Focuses the care plan on quality of life, effective utilization of resources, and facilitates goal achievement and movement through the continuum of care. Collaborates with patient/family, physician, and health care team for final agreement with treatment goals, timeframes and coordination of care. Develops additional and contingency plan options with patient/family when planning for discharge.
  • Educates nursing, medical and ancillary staff about care management role, relevant clinical criteria and resources available for patients, as well as regulatory and managed care requirements. Demonstrates an understanding of the vision and goals of the care management program. Demonstrates an understanding of the core functions of the care management role. Demonstrates an understanding of and effectively communicates information relative to clinical criteria and resources available for patients/families to the healthcare team. Serves as a resource for other members of the health care team by participating in or conducting formal/informal in-service education as needed. Identifies own practice abilities and limitations and obtains instruction and supervision as necessary. This includes seeking education for self development.
  • Participates in departmental, interdisciplinary, hospital and Medical Board committees as appropriate. Participates in departmental, interdisciplinary, hospital and Medical Board committees as requested. Represents the voice of Care Management in committee participation. Completes committee assignments as requested. Provides feedback and periodic reports to Care Management at departmental meetings and senior managers on relevant issues.
  • Acts as advocate/facilitator in all cases with insurance related issues, delays in treatments and/or diagnostic tests. Collaborates with the interdisciplinary team to maintain appropriate levels of care to facilitate movement of the patient through the continuum. Identifies and documents delays in treatment and processes. Understands basic reimbursement systems and identifies potential payor issues relative to delays in treatments and/or diagnostic tests. Assists in developing strategies to decrease avoidable days. Demonstrates and communicates the value of avoidable days and/or additional documentation to justify acute inpatient hospitalization.
  • Communicates the outcome of chart review and managed care company telephonic review with the health care team as appropriate. Conducts accurate reviews using CMS, Milliman Care Guidelines and the patients chart as the primary source of information. Performs and documents initial certification and continued stay reviews within appropriate time frame and in appropriate system. Documents obtained payor authorization in a complete, timely and concise manner. Maintains follow-up communication with payor as required for authorization of hospital stay. Notifies health care team of outcomes of communication with payor and authorization status. Notifies departmental manager of all unresolved utilization problems/issues.
  • Coordinates discharge appeals or issuance of Hospital Notices in accordance with State and Federal Regulations and departmental guidelines. Demonstrates an understanding of the CMS and NY State regulations for discharge appeals and issuance of Hospital Notices. Follows procedures for issuing Hospital Notices when appropriate and communicate necessary information to healthcare team relative to patients benefits. Facilitates issuance of the Important Message from Medicare within 24 48 hours before discharge and the Detailed Notice of Discharge if indicated. Effectively communicates the initiation of a discharge appeal to the health care team. Coordinates the collection of medical record documentation for review by the review agent (i.e., IPRO, managed care carrier). Communicates outcome of discharge appeal to patient/family and health care team.
  • Effectively communicates information relative to a potential denial to the appropriate members of the health care team. Communicates timely, complete, and accurate information relative to a potential denial to the appropriate members of the health care team. Demonstrates an understanding of the peer-to-peer appeal process for authorization of acute inpatient hospitalization. Effectively monitors, documents and informs members of the health care team the outcome of the peer-to-peer appeal process. Demonstrates an understanding of CMS, Milliman Care Guidelines relative to the patients diagnosis and condition when providing a clinical review to the payor to prevent a potential denial. Effectively communicates the impact on reimbursement to the hospital for potentially denied days to the health care team. Utilizes the chief of service/physician advisor per departmental guidelines.
  • Ensures identification of variances and the development of appropriate contingency plans for each phase of care in the event of patient health complications or systems barriers. Communicates with the attending physician/hospitalist, patient/family and staff regarding alteration in plan. Monitors test results, patient responses to interventions, health status and makes recommendations for revisions to treatment plan based on patient need and responses. Evaluates and communicates changes in patients clinical condition timely. Documents medical plan of care and reflects patients progress in meeting prescribed plan.
  • Facilitates timely and appropriate communication among attending physicians, nurse practitioners, physician assistants, patients, family members, other members of the health care team, external providers and payers. Refers significant clinical issues per protocol to the attending physician and/or hospitalist or to the designated consultants. Utilizes chief of service/physician advisor to address unresolved clinical and interdisciplinary issues. Participates and contributes as a regular member of interdisciplinary rounds to communicate and receive pertinent information. Utilizes critical thinking skills and assists others to identify and resolve potential and existing problems related to coordination of patient care. Determines the best method to communicate with the interdisciplinary team about differ...