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Nurse Case Manager
2 months ago
Job Summary:
We are seeking a skilled Registered Nurse to join our team as a Nurse Case Manager. In this role, you will be responsible for coordinating patient care and ensuring that patients receive the necessary resources and support to achieve optimal health outcomes.
Key Responsibilities:
- Apply MCG criteria to monitor appropriateness of admissions and continued stays, and document findings based on Departmental standards.
- Identify at-risk populations using approved screening tool and follow established reporting procedures.
- Refer cases and issues to Medical Director and Triad Team in compliance with Department procedures and follow up as indicated.
- Communicate covered day reimbursement certification for assigned patients.
- Discuss payor criteria and issues on a case-by-case basis with clinical staff and follow up to resolve problems with payors as needed.
- Use quality screens to identify potential issues and forward information to the Quality Department.
- Facilitate removal of delays and document delays when they exist. Collaborate with the healthcare team and appropriate department in the management of care across the continuum of care by assuring communication with Triad Team and healthcare team.
Requirements:
- Bachelor's degree preferred.
- Recent experience in case management, utilization management, and/or discharge planning/home care in a high-volume, acute care hospital preferred.
- Assertive and creative in problem-solving, critical thinking skills, systems planning, and patient care management.
- Basic knowledge of computer systems with skills applicable to utilization review process.
- Understanding of Inpatient versus Outpatient surgery and ICD10-Coding (preferred) and Observation status qualifications.
- Strong analytic, data management, and PC skills.
- Working knowledge of Medicare regulatory requirements, Managed Care Plans.
Albany Medical Center is an Equal Opportunity Employer.
This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes.
Reasonable efforts, consistent with Albany Med Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.
