Overview RN/Case Manager MSH Case Management FT Days. The Case Manager (CM) will be responsible for all aspects of case management for an assigned group of patients to determine the appropriateness of the Level of Care, assist in the development of the plan of care; ensure that the plan is implemented in a timely basis and identify the expected length of stay (ELOS). The CM works collaboratively with physicians, social workers, clinical nurses, home care services, and other members of the interdisciplinary team as needed. The CM actively participates in clinical initiatives focused on reducing the length of stay (LOS), improved efficiency, quality and resource utilization. Assignment will be by units/clinical areas of practice and may require responsibility on other units/services.
Responsibilities
Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve optimal patient outcomes and appropriate reimbursement for the organization.
Performs continued stay reviews utilizing standardized criteria to justify continued inpatient stay.
Collaborates with physicians and other clinicians to expedite diagnostic testing, treatment and consultations.
Documents all clinical reviews in Case Management Documentation system.
Supports the mission, vision, philosophy and goals of the Medical Center.
Assessment of patients’ clinical, psychosocial, and functional status in collaboration with the interdisciplinary team.
Identification and documentation of variances affecting LOS and discharge planning.
Conducts follow-up of delays in treatment or reporting of results.
Plans and develops specific goals with the physician, interdisciplinary team, patient and/or family.
Implements and coordinates activities, strategies, and interventions to move the patient through the continuum of care.
Documents outcomes achieved and identifies internal and external barriers.
Identifies reasons for readmissions and collaborates with the interdisciplinary team on strategies to reduce readmission rate.
Refers cases to the physician advisor to support timely progression along the continuum of care and discharge planning.
Interacts with patient/family to discuss plan of care and coordinate services based on clinical needs and available resources.
Utilization Review: maintains knowledge of UR requirements of each payor; provides clinical information for concurrent review and contractual agreements; works with physicians and managed care companies on concurrent denial appeals.
Communicates clinical information to the payor as needed, coordinating between physician and payor Medical Director as required.
In psychiatry, documents UR notes in the medical record per OMH guidelines.
Discharge Planning: assess, communicate and monitor the discharge planning process; obtain authorizations for post-discharge services; assess clinical readiness and complete PRI for Residential Health Care Facility placement.
Liaison with the financial department for current insurance coverage.
Collaborates and participates in the appeals process with the interdisciplinary team.
Collaborative Relationships: develop and maintain effective working relationships with the interdisciplinary team and Case Managers within managed care organizations; participate in nursing orientation; interface with other departments.
Qualifications
Education Requirements : Bachelors Degree in Nursing; Masters preferred.
Experience Requirements : Previous experience in home care, long term care or utilization review preferred; Discharge Planner or Case Manager preferred; Manager or a minimum of 3-5 years experience as an RN in an acute care setting.
Licensing And Certification Requirements : Current NYS RN nursing license; CCM certification preferred. Re-credentialing of CCM status expected. PRI Certification (to be obtained within 1 year). Basic Life Saver (BLS) certification.
Employer Description
The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a dedication to delivering outstanding patient care and encourage participation in creating a culture that ensures fair access to opportunities and inclusive practices. Our leaders are committed to fostering a respectful workplace and continuous improvement to enhance patient care and staff experience.
Compensation
The Mount Sinai Health System provides salary ranges that comply with applicable laws. The salary range for this role is $63.28 - $63.28 hourly. Actual salary depends on experience, education, and operational need. The range listed does not include bonuses or other compensation.