Skip to Main Content
← Back to Jobs

Full Time Case Manager- Peconic Bay Medical Center

Northwell Health Riverhead ,NY
  • Expired: March 26, 2020. Applications are no longer accepted.

Req Number 0031AY
Job Description
POSITION
SUMMARY
Serves as liaison between the patient and facility/physician. Ensures a continuum
of quality patient care throughout hospitalization and oversees provisions
for patient's discharge. Assesses, plans, oversees and evaluates the
appropriateness of care throughout admission and hospitalization of
the patient.
RESPONSIBILITIES
*****
*****
*****
*****
*****
*****
*****
1. Facilitates patient management throughout hospitalization.

  • Participates in patient management rounds and patient centered meetings.
  • Identifies potential delays and resolves issues with appropriate departments.
  • Identifies appropriate utilization of Social Work Services and makes referrals when appropriate.
  • Confers with physician regarding referrals for Physical Therapy, nutrition, speech and swallow.
1. Serves as an in-patient liaison - planning, assessing, implementing and evaluating patient in collaboration with the health care team.
  • Serves as a resource to the health care team regarding quality, utilization of clinical resources, payer, and reimbursement issues.
  • Works with on-site screeners in transitioning patients to appropriate post discharge settings.
  • Collaborates with payers, providing all necessary clinical documentation for the maximization of benefits.
  • Serves as a liaison to patient, family, admitting, primary care physician, health care team, and hospital departments.
  • Collaborates with and provides feedback to the multidisciplinary team regarding patient's status with regard to length of stay, utilization of resources and discharge status.
1. Provides support to the in-patient health care team as well as to patient and family regarding all aspects of admission, hospitalization and discharge plan.
  • Involves patient and/or family in discussion and planning for anticipated need for care following discharge.
  • Ensures patient and/or family are given information regarding their choices regarding transferring the patient to another level of care according to regulatory standards.
1. Performs concurrent utilization management.
  • Conducts chart review for appropriateness of admission and continued length of stay.
  • Contacts and interacts with third party payers to obtain approval of hospital days, pre-certification and post-discharge eligibility in relation to clinical course.
  • Ensures compliance with current state, federal, and third party payer regulations.
  • Identifies patients for Alternate Level Care (ALC) care list and notifies appropriate health team members.
  • Communicates with insurance companies and physicians regarding utilization issues.
  • Utilizes important message from Medicare (IMM) when appropriate.
  • Ensures managed care reviews are up to date and accurately reflect patient's clinical progress and acute needs.
1. Participates in the quality management of patient care outcomes.
  • Submits data to management regarding case management and/or quality initiatives.
  • Participates in data collection regarding patient's length of stay, utilization of clinical resources, IPRO citations including appropriate recommendations and re-admission within 30 days.
1. Initiates appropriate discharge planning as supported by initial assessment at time of admission.
  • Reviews patient's chart.
  • Assesses each patient physically, psychosocially and financially.
  • Assesses patient's support system to facilitate appropriate discharge to community.
  • Substantiates, with the physician, the need for home care services.
  • Coordinates procurement of any supplies, equipment or home lab work needed by patient to evaluate discharge.
  • Arranges for post-hospital transportation, when indicated.
  • Interacts and coordinates with community agencies, families, vendors facilities and institutions to facilitate patient discharge.
1. Documents the case management process in the medical record.
  • Documents on-going processes of patients' hospitalization.
  • Documents finalized discharge plan and disposition.
  • Completes applicable areas of the Patients Discharge Instruction Sheet and the Patient Transfer Sheet.
  • Ensures Patient Review Instrument (PRI) is completed and reflects clinical profile of the patient.
  • Ensures case management sheet is current and accurate.
1. Performs related duties, as required.
***ADA Essential Functions**
Qualifications
REQUIRED
EXPERIENCE AND QUALIFICATIONS

  • Bachelor's
Degree in Nursing, required.

  • Current license to practice as a Registered
Professional Nurse in New York
State.

  • Case
Management Certification, preferred.

  • Minimum of one (1) year related
experience, required. Experience in case management and clinical pathways,
variance analysis and trending, quality management/utilization review and
home care/discharge planning, preferred.

  • Keeps abreast of developments in the field and serves
as a resource to other staff.

Northwell Health

Address

Riverhead, NY
11901 USA