Utilization Case Manager Jobs in Connecticut (NOW HIRING)

Description

Weekends and Holidays, 8:30 am-5:00pm

Rate: $51.50 hrly

Northwell is the largest not-for-profit health system in the Northeast, serving residents of New York and Connecticut with 28 hospitals, more than 1,000 outpatient facilities, 22,000 nurses and over 20,000 physicians. Northwell cares for more than three million people annually in the New York metro area, including Long Island, the Hudson Valley, Connecticut and beyond, thanks to philanthropic support from our communities. Northwell is New York State’s largest private employer with over 104,000 employees — including members of Northwell Health Physician Partners — who are working to change health care for the better.

Summary:

The Case Manager RN, working in conjunction with the centralized denial prevention team, partners with the local interdisciplinary care team to facilitate the progression of care for the hospitalized patient. Together with the medical provider, the Case Manager RN collaborates with all members of the care team, focusing on the delivery of efficient, high-quality care. This position ensures the appropriate utilization of clinical resources with a goal of a safe and timely discharge for the patient. This role navigates health system services to support effective transitions while advising the team on healthcare industry compliance. The Case Manager RN must be adept at driving throughput metrics, clinical effectiveness, and fiscal responsibility.

Responsibilities:

1. Initially screen all patients early in the hospitalization, particularly for patients likely to have post-acute needs and every 1-2 days throughout their stay to facilitate care progression to establish an anticipated length of stay and transition planning needs.
2. Collaborates with the medical team to formulate a treatment plan to include care transitions and promote patient flow.
3. Completes an initial assessment of all admissions/observation patients to identify barriers that impact the length of stay and discharge planning. The assessment should also identify the needs of the patients, acknowledge current resources available, and anticipate future resources needed to facilitate successful transitions.
4. Navigates the care delivery system while collaborating with the physician and other clinical departments by ensuring that tests, treatments, consults, and procedures are appropriately indicated and performed timely.
5. Articulates the plan of care and communicates this plan to other care team members and patient/caregiver. Intervenes to maintain care progression when a deviation in the plan occurs.
6. Creates and coordinates the overall transition plan of care based on initial assessment and concurrent collaboration with social workers, direct care providers, other hospital departments, external service organizations, agencies and healthcare facilities, community care and navigation services, and the patient and family/caregiver.
7. Case Management facilitates daily Multi-Disciplinary Rounds (MDRs) incorporating evidence/best practice milestones in the plan and communicates that plan to the health care team.
8. Apprises the interdisciplinary team of the estimated length of stay, care progression barriers, and anticipated disposition. Identifies what is needed from the team to facilitate the plan.
9. Facilitates smooth care transitions by ensuring appropriate clinical follow-up is arranged and referrals to proper post-acute providers are initiated.
10. Communicates the plan effectively with the patient and family/caregiver making certain that they have resources for success post-discharge. Understands organizational goals for the length of stay and unplanned readmissions
11. Proactively interfaces with the payer, where required, verifying coverage/benefits for anticipated discharge needs and obtaining authorization for post-acute care.
12. Identifies patients that are readmitted or at high risk for unplanned readmissions and initiates appropriate interventions. Identifies organizational resources within the community and engages those resources as necessary.
13. Documents avoidable days (if not captured by another Care Transitions Team member), case management assessments, and care plans in a thorough and timely manner, per department policy.
14. Ensures appropriate care provider documentation to support the patients anticipated discharge plan of care. Escalate deviations from the plan to the Physician Advisor as appropriate.
15. Completes clear and concise documentation of the care plan and communicates this to the interdisciplinary team and the patient/caregiver.
16. Identifies and communicates any problems or issues affecting patient flow, patient satisfaction, safety, length of stay management, or outcomes to the department director and/or appropriate key stakeholder.
17. Functions as a resource for governmental and health care industry regulations and ensures compliance, communicates standards to the interdisciplinary team.
18. Informs the patient and family/caregiver of the plan of care and the plan progression. Facilitates communication with the providers and encourages open dialogue.
19. Facilitates Care Partner Huddles/Family meetings as needed.
20. Attends and contributes to departmental staff meetings.
21. Participates and contributes to multi-disciplinary committees and other committees or workgroups as directed.
22. Manages quality indicators such as avoidable delays, length of stay, resource utilization, patient satisfaction, patient flow, outlier management, and readmissions while suggesting strategies to improve organizational/departmental performance.
23. Assists with completion of PRIs upon request and as needed.
24. Maintains and models the organizations values
25. Demonstrates regular, reliable and predictable attendance. 26. Performs other duties as required.

Education Skills Experience:

Required: This position requires a minimum formal education of Associate Degree in Nursing and minimum of three years job-related experience. Registered Nurse license State of CT with minimum of one year as an acute Care Coordinator.

 Knowledge and expertise with use of electronic medical record and use of both Interqual and Milliman screening criteria.

Excellent collaborator and team member who is able to work closely with physicians and all members of the health care team to procure the right level of care, correct order for hospitalization, optimal plan of care, and facilitation of services.

 Knowledge and expertise in both CMS and insurance industry standards as well as guidelines pertaining to appropriate coverage notifications.

Ability to be flexible, resourceful and creative in problem solving.

Excellent communication skills both oral and written

Minimum Experience: three years

Desired: Certification in Case Management preferred or willing to obtain. Bachelors Degree in Nursing preferred.

Other Information:

Working Conditions:

Manual: Little or no manual skills/motor coord & finger dexterity

Occupational: Little or no potential for occupational risk

Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force

Physical Environment: Generally pleasant working conditions

Company: Norwalk Hospital Association

Org Unit: 374

Department: Care Coordination-NH

Exempt: No