Care Manager (RN) - Per Diem
NYU Langone Hospitals, East Garden Mobile Home Village, KS, United States
NYU Langone Hospital—Long Island
is a 591-bed university-affiliated medical center that offers diagnostic and therapeutic care across many specialties. It is committed to medical education, research, and inclusive services.
Position Summary
We have an exciting opportunity to join our team as a Care Manager (RN) – Per Diem. In this role, the successful candidate coordinates and procures services required to meet post‑acute care needs, ensuring timely transitions, collaborating with interdisciplinary staff, and participating in quality improvement and evaluation processes.
Job Responsibilities
Performs other duties as assigned.
Performs an initial utilization review of patients for appropriateness of setting using industry standard utilization clinical criteria including InterQual, Milliman Care Guidelines (MCG), etc. Collaborates with the Attending of record and the Physician Advisor as indicated for review of any patient not meeting criteria for level of care ordered. Performs continued stay and extended stay reviews when there is a change to a higher level of acuity, authorized days expire, required by the insurance payer contractual agreement, stay is denied or reduced to a lower level of care.
Provides patient clinical reviews to payer in a timely and efficient manner to obtain certification of the patient days and secure reimbursement. Confers with Attending Physician, Physician Advisor, and multidisciplinary team as needed to mediate concurrent denials.
Screens all inpatients utilizing case management departmental screening criteria for potential post acute care needs. Performs an assessment for discharge needs for all patients that meet screening criteria, are referred by care team or are requested by patient/designee. Develops a discharge plan in collaboration with the patient/designee and care team incorporating patient preferences. Implements the discharge plan with referrals, including necessary medical information, to appropriate post acute care services. Reassessment of this process will be done with ongoing review of all readmissions to ensure that the plan was responsive to the discharge needs.
Completes all necessary documentation as per departmental policy and procedure utilizing Allscripts. Completes Patient Review Instrument (PRI) accurately and in a timely manner.
Identifies and reports risk and quality issues to appropriate department. Tracks avoidable days in Allscripts to identify opportunities for improvement.
Provides patients with all necessary notices in accordance with requirements for CMS conditions of participation and insurance payer contracts. Issues Important Message (IM), Discharge Notice, Advanced Beneficiary Notice (ABN), Detailed Notice of non‑coverage, Preadmission/Admission Notice of non‑coverage and Hospital Issuance of non‑coverage (HINN) as appropriate and in accordance with hospital policy and procedure. Processes Medicare Code 44 as appropriate in accordance with policy. Ensures patient/designee is provided with explanation of billing status when a Code 44 or observation is ordered.
Participates in patient care unit interdisciplinary meetings to assess patients' current and projected clinical status, plan of care, discharge plan and expected discharge date. Facilitates communication among the interdisciplinary health care team members. Coordinates patient care conferences among appropriate team members and patient/designee to discuss identify barriers, concerns, resolve conflicts and communicate choices in the plan of care. Participates in in-service activities and continuing education programs as scheduled.
Minimum Qualifications
Bachelor's degree in Nursing (required for employees hired after 9/1/2020; prior hires are grandfathered).
Current and valid New York State Registered Nurse License.
BLS certification issued by the American Heart Association‑AHA.
3‑5 years of clinical acute‑care experience.
Excellent communication, interpersonal, and organizational skills.
Knowledge of clinical standards of practice for multiple patient populations.
Computer skills.
Preferred Qualifications
Experience with Post‑Acute Care referral processes and procurement of patient services.
Experience with Hospital reimbursement process, insurance denials and appeals.
Provider with New York State Department of Health Patient Review Instrument (PRI) Assessor training.
3‑5 years of discharge planning and/or utilization management experience.
Compensation
Salary range: $75.00–$75.00 per hour. Actual salaries depend on experience, specialty, education, and hospital need.
Equal Opportunity and Inclusion
NYU Langone Hospital—Long Island is an equal‑opportunity employer and is committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration.
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is a 591-bed university-affiliated medical center that offers diagnostic and therapeutic care across many specialties. It is committed to medical education, research, and inclusive services.
Position Summary
We have an exciting opportunity to join our team as a Care Manager (RN) – Per Diem. In this role, the successful candidate coordinates and procures services required to meet post‑acute care needs, ensuring timely transitions, collaborating with interdisciplinary staff, and participating in quality improvement and evaluation processes.
Job Responsibilities
Performs other duties as assigned.
Performs an initial utilization review of patients for appropriateness of setting using industry standard utilization clinical criteria including InterQual, Milliman Care Guidelines (MCG), etc. Collaborates with the Attending of record and the Physician Advisor as indicated for review of any patient not meeting criteria for level of care ordered. Performs continued stay and extended stay reviews when there is a change to a higher level of acuity, authorized days expire, required by the insurance payer contractual agreement, stay is denied or reduced to a lower level of care.
Provides patient clinical reviews to payer in a timely and efficient manner to obtain certification of the patient days and secure reimbursement. Confers with Attending Physician, Physician Advisor, and multidisciplinary team as needed to mediate concurrent denials.
Screens all inpatients utilizing case management departmental screening criteria for potential post acute care needs. Performs an assessment for discharge needs for all patients that meet screening criteria, are referred by care team or are requested by patient/designee. Develops a discharge plan in collaboration with the patient/designee and care team incorporating patient preferences. Implements the discharge plan with referrals, including necessary medical information, to appropriate post acute care services. Reassessment of this process will be done with ongoing review of all readmissions to ensure that the plan was responsive to the discharge needs.
Completes all necessary documentation as per departmental policy and procedure utilizing Allscripts. Completes Patient Review Instrument (PRI) accurately and in a timely manner.
Identifies and reports risk and quality issues to appropriate department. Tracks avoidable days in Allscripts to identify opportunities for improvement.
Provides patients with all necessary notices in accordance with requirements for CMS conditions of participation and insurance payer contracts. Issues Important Message (IM), Discharge Notice, Advanced Beneficiary Notice (ABN), Detailed Notice of non‑coverage, Preadmission/Admission Notice of non‑coverage and Hospital Issuance of non‑coverage (HINN) as appropriate and in accordance with hospital policy and procedure. Processes Medicare Code 44 as appropriate in accordance with policy. Ensures patient/designee is provided with explanation of billing status when a Code 44 or observation is ordered.
Participates in patient care unit interdisciplinary meetings to assess patients' current and projected clinical status, plan of care, discharge plan and expected discharge date. Facilitates communication among the interdisciplinary health care team members. Coordinates patient care conferences among appropriate team members and patient/designee to discuss identify barriers, concerns, resolve conflicts and communicate choices in the plan of care. Participates in in-service activities and continuing education programs as scheduled.
Minimum Qualifications
Bachelor's degree in Nursing (required for employees hired after 9/1/2020; prior hires are grandfathered).
Current and valid New York State Registered Nurse License.
BLS certification issued by the American Heart Association‑AHA.
3‑5 years of clinical acute‑care experience.
Excellent communication, interpersonal, and organizational skills.
Knowledge of clinical standards of practice for multiple patient populations.
Computer skills.
Preferred Qualifications
Experience with Post‑Acute Care referral processes and procurement of patient services.
Experience with Hospital reimbursement process, insurance denials and appeals.
Provider with New York State Department of Health Patient Review Instrument (PRI) Assessor training.
3‑5 years of discharge planning and/or utilization management experience.
Compensation
Salary range: $75.00–$75.00 per hour. Actual salaries depend on experience, specialty, education, and hospital need.
Equal Opportunity and Inclusion
NYU Langone Hospital—Long Island is an equal‑opportunity employer and is committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration.
#J-18808-Ljbffr