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Care Manager
4 months ago
**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 _nyulangone.org_, a_nd 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 Care Manager (RN).
**Responsibilities**:
- 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.
- Applies customary protocols, pathways, evidence-based processes and other means of managing patient care. Utilizes protocols, pathways and order sets to formulate, communicate and ensure implementation of the patient plan of care. Utilizes multidisciplinary team to address individualized patient needs. Develops realistic goals with multidisciplinary team for patient to achieve milestone activities within appropriate timeframes. Demonstrates flexibility with plan of care to meet patient needs..
- Supports the mission, philosophy, standards, goals and objectives of NYU Hospitals Center and Care Management Program. Contributes to the development of the goals and objectives of the Care Management Program consistent with the objectives of NYU Hospitals Center. Understands, applies and supports departmental/hospital policies, procedures and standards. Observes at all times legal and ethical considerations pertaining to patients and hospital personnel. Initiates programs for improving cost effectiveness in coordination of patient care. Assists managers to create a participative environment in department based meetings and other activities. Analyzes and develops systems to improve processes and outcomes in collaboration with managers.
- 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.
- 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.
- 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.
- Assesses patient and medical record documentation for appropriate
