Case Manager (BSN) Full Time -Evenings

Strength Through Diversity

Ground breaking science. Advancing medicine. Healing made personal.

Roles & Responsibilities:

• The Case Manager is responsible for all aspects of case management/ utilization review for an assigned group of inpatients, ED patients and Observation ( RETU) patients to determine the correct Level of care ( LOC), appropriateness of the admission and continued stay, 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 case manager works collaboratively with physicians, social workers, clinical nurses, home care services, and other members of the interdisciplinary team as needed to develop a plan of care which includes discharge planning, resource management, health education, and the provision of information as it relates to care management and the transition of care. The Case Manager actively participates in specific clinical initiatives focused on LOC, reducing the length of stay (LOS), improved efficiency and quality and resource utilization. Assignment will be by units/clinical areas of practice and may require responsibility on other units/services.

Responsible For

A group of inpatients to determine the appropriateness of the admission and continued stay, 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) and problem solves care transitions accordingly within the interdisciplinary health care team.

Duties and Responsibilities:

1. 1. Principal Duties and Responsibilities

Principle Duties and responsibilities include, but are not limited to:

• Review and advice for appropriate level of care using criteria sets (refer to designated site software), cases referred or who have Observation diagnosis, or other high risk diagnosis as well as readmissions.
• Review all patients in RETU to insure they meet Observation criteria, assist with discharge or admit to next LOC with-in unit specified timeframes.
• 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.
• Oversee clinical throughput of patient, ensuring medical treatment plan, e.g., timely tests, consults.
• Collaborates with Physicians and other clinicians to expedite diagnostic testing, treatment and consultations.
• Documents all clinical reviews in using designated site software program.
• Supports the mission, vision, philosophy and goals of the Medical Center.
• Promotes an environment that is sensitive to cultural diversity and is open and responsive to the diverse backgrounds and experience of others.
• Liaison with Physician Advisor.

1. 1. Case Management:

• Assessment of the patient's clinical, psychosocial, and functional status in collaboration with the interdisciplinary team.
• Identification and documentation of variances affecting the LOS and the discharge planning process.
• Conducts follow-up of any delays in treatment or reporting of results.
• Planning/developing specific goals with the physician, interdisciplinary team, and the patient and/or family.
• Implementation and coordination of specific activities, strategies, and interventions to move the patient through the continuum of care.
• Determine ALC status and track avoidable days.
• Documentation of outcomes achieved and identified internal and external barriers.
• Identifies reasons for readmissions and collaborates with interdisciplinary team on strategies to reduce readmission rate.
• Appropriately identifies and refers cases to the physician advisor to support timely progression of patients along the continuum of care and (appropriate) discharge planning.
• Interacts with patient/family to discuss plan of care and coordination of services based on clinical needs and available resources.

1. 1. Utilization Review:

• Maintains a working knowledge of the UR requirements of each payor within the patient population
• Provides the clinical information requested by the managed care companies as part of the concurrent review in a timely fashion.
• Provides clinical information requested by the managed care companies in accordance with contractual agreements.
• Works collaboratively with physicians and managed care companies on concurrent denial appeals
• Communicates clinical information to the payor, as needed, coordinating direct communication between physician and payor Medical Director as required.
• Performs additional duties as assigned.

1. 1. Discharge Planning

• Responsible for assessment, communication and monitoring of discharge planning process in collaboration with the clinical nurse initiates the discharge planning process on admission.
• In collaboration with Social worker, obtains authorizations from managed care companies for post-discharge services.
• Assesses for clinical readiness and completes the Hospital and Community Patient Review Instrument (PRI) for patients requiring Residential Health Care Facility placement.
• Assist in having appropriate staff complete discharge forms in a timely manner.
• Coordinates the Discharge Appeal process.
• Liaison with financial department for current insurance coverage.
• Collaborates and participates in concurrent denial and appeals process with all members of the interdisciplinary team.

1. 1. Communication and Collaborative Relationships

• Develops and maintains effective working relationships with interdisciplinary team and with managed care/community organizations.
• Interfaces with other departments within the Hospital effectively.
• Demonstrates a professional, courteous and respectful attitude in dealing with patients/families/care givers and members of the health care team

1. 1. Educational/Professional Development

• Participates in the development of unit based staff.
• Meets regulatory, licensure and annual health assessment requirements.
• Identifies own learning strengths and needs through ongoing self assessment
• Utilizes learning resources.
• Seeks educational opportunities to maintain and enhance competence within current advances in health care delivery and case management
• Provides presentations and educational offerings as needed.
• Participates in special projects and committees.
• Attends relevant workshops, conferences and seminars
• Demonstrates membership in professional and related organizations.
• Demonstrates competence in case management and required information technology and systems.

Requirements:

• Licenses:

1. RN, BLS

Strength Through Diversity

The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you become a part of Mount Sinai's unrivaled record of achievement, education, and advancement as we revolutionize medicine together. We invite you to participate actively as a part of the Mount Sinai Health System team by:

• Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential
• Serving as a role model confronting racist, sexist, or other inappropriate actions by speaking up, challenging exclusionary organizational practices, and standing side-by-side in support of colleagues who experience discrimination
• Inspiring and fostering an environment of anti-racist behaviors among and between departments and co-workers

We work hard to acquire and retain the best people and to create an inclusive, welcoming and nurturing work environment where all feel they are valued, belong, and are able to professionally advance. We share the belief that all employees, regardless of job title or expertise, contribute to the patient experience and quality of patient care.

Explore more about this opportunity and how you can help us write a new chapter in our history!

Who We Are

Over 42,000 employees strong, the mission of the Mount Sinai Health System is to provide compassionate patient care with seamless coordination and to advance medicine through unrivaled education, research, and outreach in the many diverse communities we serve.

Formed in September 2013, The Mount Sinai Health System combines the excellence of the Icahn School of Medicine at Mount Sinai with seven premier hospitals, including Mount Sinai Beth Israel, Mount Sinai Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai West (formerly Mount Sinai Roosevelt), Mount Sinai St. Luke's, and New York Eye and Ear Infirmary of Mount Sinai.

The Mount Sinai Health System (MSHS) provides equal employment opportunity to all its employees and applicants for employment without unlawful discrimination on the basis of their actual or perceived race, creed, color, religion, national origin, sex, gender, gender expression, gender identity, age, disability, marital or parental status, sexual orientation, veteran, immigration, citizenship, or other protected status.

EOE including Veterans and Disabled

Compensation

The Mount Sinai Health System (MSHS) provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $101,518.12 - $106,137.06 Annually. Actual salaries depend on a variety of factors, including experience, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.