Job Description: The Clinical Nurse Case Manager (CNCM) will be responsible for all aspects of Case Management for an assigned group of inpatients to determine the appropriateness of the admission and continued stay, assists in the development of the Plan of Care, ensures that the plans is implemented in a timely basis, and identifies the expected length of stay (ELOS).
The CNCM works collaboratively with Physicians, Social Workers, Clinical Nurses, Home Care Services, and other members of the interdisciplinary team.
The CN CM actively participates in specific clinical initiatives focused on reducing the length of stay (LOS), improved efficiency, quality, and resource utilization.
Assignment will be by units/service and may encompass responsibility on other units/services.
Principle Duties and responsibilities include, but are not limited to: I.
Patient Clinical Review a.
Reviews all new admissions to identify patients where utilization review (UR), discharge planning, and/or case management will be needed using standardized criteria to achieve optimal patient outcomes and appropriate reimbursement for the organizationb Performs continued stay reviews utilizing standardized criteria to justify continued inpatient stayc Collaborates with Physician and other Clinicians to expedite diagnostic testing and treatmentd Documents all clinical reviews in Canopye Supports the mission, vision, philosophy and goals of the Medical Centerf.
Promotes an environment that is sensitive to cultural diversity and is open and responsive to the diverse backgrounds and experience of others.
II. Case Management – The CNCM process will include: a.
Assessment of the patient’s clinical, psychosocial, and functional status in collaboration with the interdisciplinary teamb Identification and documentation of variances affecting the LOS and the discharge planning processc Conducts follow-up of any delays in treatment or reporting of resultsd Planning/developing specific goals with the interdisciplinary team and the patient and/or familye Implementation and coordination of specific activities, strategies, and interventions to move the patient through the continuum of caref Documentation of outcomes achieved and identified internal and external barriers.
g.
Identification of reasons for readmissions and collaborating with interdisciplinary team on strategies to reduce readmission rateh Appropriately identifying and referring cases to the Physician Advisor in an effort to support timely progression of patients along the continuum of care and (appropriate) discharge planningi Interacts with the patient/family/caregiver to discuss Plan of Care and coordination of services based on clinical needs and available resources.
III. Utilization Review: a.
Maintains a working knowledge of UR requirements of each Payor within the patient populationb Provides clinical information requested by the Managed Care Companies as part of the concurrent review in accordance with contractual agreementsc Provides education as needed to Managed Care Companies regarding current clinical intervention and rationale for treatment, and/or continued stayd Works collaboratively with Physicians and Managed Care companies on concurrent denial appealse Communicates clinical information to the Payor, coordinating direct communication between Physician and Payor medical director as requiredf In Psychiatry will document UR notes in the medical record as per OMH guidelines.
IV. Discharge Planning: a.
Responsible for assessment, communication, and monitoring of discharge planning processb Obtains authorizations from Managed Care companies for post-discharge servicesc Assesses for clinical readiness and completes the Hospital and Community Patient Review Instrument (PRI) for patients requiring Residential Health Care Facility placementd Liaisons with financial department for current insurance coverage.
e.
Collaborates and Participates in the Appeals Process with all members of the Interdisciplinary team.
V.
Reporting Relationships Reports to the Case Management Clinical Nurse Manager.
VI. Collaborative Relationships: Develops and maintains effective working relationships with interdisciplinary team, Case Managers in Managed Care Companies.
Interfaces with other departments in the Medical Center as necessary.
Participates in nursing orientation.
VII. Work Schedule: The basic work week consists of 5 work days.
Work hours may vary depending on patient care issues.
VIII.
Knowledge, Skills and Abilities Required a Minimum of 3-5 years experience as a RN in an acute care setting in an appropriate area of specialty, or equivalent experience b.
Basic knowledge of community resourcesc Clinical, written, verbal, and interpersonal skills to work effectivelyd Ability to work independently and collaboratively with the interdisciplinary team, patient/family, and others.
Job Qualifications: 1Ability to read, write, understand and speak English in a clear and concise manner2Visual and aural acuity to assess patient status3Communication and interpersonal skills to work effectively with a wide variety of individuals4Ability to use basic data entry and retrieval systems5Ability to organize information and teach others6Analytic ability to collect and organize information, identify problems and trends, and formulate and implement corrective plans or programs7Ability to coordinate, prioritized, and allocate resources8Oriented to consumer satisfaction9Physical stamina, dexterity and mental health necessary to coordinate a broad variety of services and programs for designated patient population on a daily basis.10.Demonstrate the following minimum requirements: a.
Licensure: New York State License with current registration.
b.
Education: Baccalaureate Degree in Nursing is required.
Master’s in Nursing and CCM certification are preferred
Case Manager Job in New York , New York US