Case Manager RN

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. At NYU Langone Health, equity and inclusion are fundamental values. We strive to be a place where our exceptionally talented faculty, staff, and students of all identities can thrive.

We embrace inclusion and individual skills, ideas, and knowledge.

We have an exciting opportunity to join our team as a Case Manager RN required. In this role, the successful candidate The Case Manager is responsible to coordinate and ensure that the interdisciplinary plan of care and the discharge plan are consistent with the patients clinical course, continuing care needs and covered services. The Case Manager encourages and facilitates a high level of collaboration and identifies and cultivates relationships with key stakeholders.

The Case Manager utilizes an understanding of statistical & financial information to solve problems. The Case Manager participates in departmental and hospital wide process improvement activities.

• Performs other duties as assigned or volunteered in alignment with medical center mission, goals and values
• Assesses patient needs in collaboration with the interdisciplinary team to develop a comprehensive management plan, documenting the assessment and plan in Allscripts, with printed/electronic copies to the medical record.
• Conducts Performance Management monitoring and participates in problem identification and solutions to improve key processes/ systems/patient care
• Participates in unit, departmental and hospital-based councils/activities/special projects.
• Assimilates LMC core values Dignity, Respect, Inclusivity, Compassion throughout all processes and interactions.
• Utilizes effective conflict-resolution strategies when dealing with staff, physicians and family members.
• Responds to patient/family needs in timely, positive manner and ensures service excellence among all staff.
• Assumes ownership/ accountability for process improvement efforts
• Works effectively in uncertain situations
• Assimilates complex information and concepts
• Responds flexibly to shifting priorities and rapid change.
• Obtains third party payer certification for patient status change, information needed for discharge.
• 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. Ensures that the team is actively working towards transition to the next level of care and identified expected discharge date.
• 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, working with the clinical staff to ensure that such services are scheduled and approval obtained to facilitate the appropriate discharge and follow up.
• Facilitates efficient care processes and follows through on delays in work-up, treatment and/ or discharge. Expedites testing/procedures to prevent avoidable delays and facilitate movement towards next level of care.
• 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
• Assess 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…