Healthcare Quality Manager

2 weeks ago

New York, New York, United States NYC Health Hospitals Full time
Job Description

Kings County Hospital Center, a leading healthcare facility, is seeking a skilled professional to join our team as an Accountable Care Manager. With a rich legacy in medicine, our hospital continues to be on the forefront of technology and provides state-of-the-art care.

Responsibilities
  1. Review patient charts to ensure documentation supports plan of care and justifies admission and continued stay.
  2. Coordinate and participate in multidisciplinary rounds to review plan of care, discuss estimated length of stay, and appropriateness of resources utilization.
  3. Collaborate with physicians and other healthcare professionals to identify and implement solutions to barriers, and collect and analyze related data.
  4. Communicate with hospital investigation/reimbursement department and third-party payers to obtain authorizations and ensure appropriate reimbursement.
  5. Develop and implement strategies to reduce length of stay, resource consumption, and achieve positive client/patient outcomes.
  6. Initiate discharge planning by assessing client/patient and family needs, including non-medical psychosocial needs and post-discharge medical needs.
  7. Coordinate and facilitate timely implementation of discharge plans for patients, ensuring timely completion of discharge, transfer, and referral forms.
  8. Perform post-discharge phone calls to verify successful linkage to care and facilitate care delivery across the continuum.
  9. maintain effective communication with physicians, nursing staff, clients/patients, families, and others related to discharge planning.
  10. Ensure timely submission of reports and necessary information for continuing care to receiving unit care manager, social worker, and next level of care providers.
  11. Collect data on variances from screening criteria, analyze data, and identify opportunities to improve processes and promote leading practices.
  12. Communicate incidents potentially compensable to Risk Management and act as financial liaison for third-party payer denials of payments.
Requirements
  • Valid New York State license and current registration to practice as a Registered Professional Nurse.
  • Baccalaureate degree in Nursing or related health field from an accredited college or university.
  • Valid and current certification in Basic Life Support (BLS) through the American Heart Association (AHA).
  • Two (2) years of experience as a Registered Professional Nurse.

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