NYU Langone Hospital - Brooklyn is a full-service teaching hospital and Level I trauma center located in Sunset Park, Brooklyn. The hospital is central to a comprehensive network of affiliated ambulatory and outpatient practices, and serves as NYU Langone Health's anchor for healthcare access, growth, and delivery in the entire borough. Learn more about NYU Langone Hospital – Brooklyn, and interact with us on LinkedIn, Glassdoor, Indeed, Facebook, Twitter, YouTube and Instagram.
POSITION SUMMARY: We have an exciting opportunity to join our team as a Case Manager-Family Health Centers Brooklyn. This position is responsible for care coordination with emphasis on services incurred outside the inpatient hospital setting. Care coordination includes assessing healthcare needs, identifying problems and opportunities for improvement, implementing intervention, managing the patient care transition process, assisting patients throughout care episodes, coordinating and facilitating care for patients with complex and chronic conditions, providing disease education, and promoting evidence-based healthcare services. The individual in this position works as part of an interdisciplinary team to ensure high quality outcomes for patients/families struggling with chronic disease management.
JOB RESPONSIBILITIES:
- Provide care coordination for patients including patient navigation, chronic disease management/education and interdisciplinary collaboration while complying with department and agency policies and procedures and other contractual requirements.
- Monitor remote patient monitoring tools and notify interdisciplinary team when follow-up is required to address out of range results.
- Work with patient and care team to conduct assessments that result in a comprehensive care plan that contains goals prioritized by the patient and/or provider.
- Engage patients in taking a proactive role for managing their health, medications, treatment and rehabilitation needs, and follow-up appointments and refer patients to the appropriate community based, health plan or other programs.
- Interact with relevant providers stakeholders and collaborate with relevant staff to support regular interactions with program.
- Follow evidence-based guidelines and contact standards to facilitate closure of gaps in care and encourage and use of in-network services.
- Use the Epic electronic medical record to conduct care coordination activities and comply with associated policies and procedures including those for workflow and consistent documentation.
- Participate in team-based support and contribute to ongoing program design and development as lessons are learned from the field and process improvement work is performed within the department.
- Initiate/maintain professional development plan including goals for self-improvement and to sustain clinical and NYULMC competencies; attend and participate in program/initiative teleconferences, program enhancement trainings and meetings, as required.
- Meet all other expectations and responsibilities of the program/initiative agreement as related to care coordination.
- Work in an ever-evolving environment that can include telemedicine, phone-based support, and in-person care in clinics, in the field and the community.
- Facilitates physician discussion with medical director of third party payer in an attempt to overturn potential denial.
- Assists in the appeal process (concurrently and retrospectively) for appeal of days and procedures.
- Documents clinical reviews in Allscripts, and forwards same to appropriate payer as necessary.
- Communicates salient clinical parameters through chart abstraction.
- Facilitates clinical managed care reviews to avoid technical denials.
- Collaborates with the physicians and interdisciplinary care team regarding expected LOS for specific patients utilizing MCG criteria and Medicare benchmarks.
- Prevents length of stay delays by recognizing when the acute level of care is no longer necessary and continued ongoing testing/treatment can be rendered on an outpatient basis.
- Facilitates efficient care processes and follows through on delays in work-up, treatment and/or discharge.
- Refers potentially avoidable days to physician advisor when appropriate.
- Discusses medical necessity, as identified by the use of clinical criteria, with the interdisciplinary team to facilitate timely movement to the next level of care.
- Assesses appropriateness of patient's admission, need for continued stay, level of inpatient care and discharge level of care.
- Acts as a resource to physicians/staff regarding MCG criteria for top DRGs on CM's unit.
- Coordinates post-discharge appointments with PCP to ensure cross continuum continuity of care.
- Communicates promptly and effectively with responsible medical, nursing and ancillary staff to ensure documentation adequately reflects patient clinical status, admission status and need for continued stay.
- Monitors patient progress toward goals.
- Provides informal education for hospital personnel that enhance their knowledge regarding clinical pathways, reimbursement issues, federal/state regulations, discharge planning issues and early recognition of post-hospital needs.
- Encourages and facilitates high level of collaboration with medical staff, interdisciplinary team, and agencies contracted to provide continuing care services.
- Demonstrates knowledge of disease process, available resources, and treatment modalities, assessing their quality and appropriateness for specific disabilities, illnesses and injuries.
- Avoids potentially unnecessary days through the timely completion of the PRI and home care transfer documents.
- Identifies potentially unnecessary days and discusses plan of care with treatment team to reduce or eliminate same.
- Prepares and updates PRI, using Allscripts, to reflect current changes in patient status.
- Ensures post-discharge plan of care is appropriately coordinated with and communicated to providers of post-discharge care.
- Demonstrates ability to implement an alternative plan for discharge when modifications are required.
- Coordinates and ensures that the interdisciplinary plan of care and the discharge plan are consistent with the patient's clinical course, continuing care needs and covered services.
- Identifies barriers to care and discharge and presents information to appropriate operational leaders to assist in the development of strategies for improvement.
- Anticipates and/or identifies discharge planning issues and effectively collaborates with the social worker, patient accounts representative, home care and/or skilled nursing facility liaison, other outpatient care representatives to address needs such as financial aid and/or post-acute service arrangements.
- Works to ensure that patient outcomes are achieved within established timeframes using appropriate resources.
- Demonstrates an ability to identify and shift priorities within work assignment to effectively manage patient care load.
- Collaborates daily with interdisciplinary team for assigned patients to discuss patient care planning and care facilitation.
- Discusses estimated length of stay, treatment and discharge plan with the attending physician and patient/family. Initiates discharge planning at the time of admission, and continues throughout the inpatient stay.
- Performs other duties as assigned or volunteered in alignment with medical center mission, goals and values.
MINIMUM QUALIFICATIONS:
NY State RN license BSN required. At least five years relevant clinical experience with demonstrated leadership skills required. Masters Degree in Nursing preferred. Case Management certification preferred. PRI certification preferred. Experience in Quality Improvement, Utilization Management, Case Management preferred. Microsoft Office skills required, database/spreadsheet skills preferred. Ability to learn computer programs as needed.
Willingness to devote the time required completing assigned tasks on schedule.
Qualified candidates must be able to effectively communicate with all levels of the organization.
NYU Langone Hospital - Brooklyn provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents. NYU Langone Hospital-Brooklyn is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision.
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