• * Facilitates patient management throughout hospitalization. 

• Participates in patient management rounds and patient centered meetings. 

• Identifies potential delays and resolves issues with appropriate departments. 

• Identifies appropriate utilization of Social Work Services and makes referrals when appropriate.

 • Confers with physician regarding referrals for Physical Therapy, nutrition, speech and swallow.

 • * Serves as an in-patient liaison - planning, assessing, implementing and evaluating patient in collaboration with the health care team.

 • Serves as a resource to the health care team regarding quality, utilization of clinical resources, payer, and reimbursement issues. 

• Works with on-site screeners in transitioning patients to appropriate post discharge settings. 

• Collaborates with payers, providing all necessary clinical documentation for the maximization of benefits. 

• Serves as a liaison to patient, family, admitting, primary care physician, health care team, and hospital departments.

 • Collaborates with and provides feedback to the primary care physician and multidisciplinary team regarding patient's status with regard to length of stay, utilization of resources and discharge status.

• * Provides support to the in-patient health care team as well as to patient and family regarding all aspects of admission, hospitalization and discharge plan. 

• Involves patient and/or family in discussion and planning for anticipated need for care following discharge. 

• Ensures patient and/or family are given information regarding their choices regarding transferring the patient to another level of care according to regulatory standards. 

• * Performs concurrent utilization management using Interqual criteria.

 • Conducts chart review for appropriateness of admission and continued length of stay. 

• Contacts and interacts with third party payers to obtain approval of hospital days, pre-certification and post-discharge eligibility in relation to clinical course.

 • Ensures compliance with current state, federal, and third party payer regulations. 

• Identifies patients for Alternate Level Care (ALC) care list and notifies appropriate health team members.

 • Communicates with insurance companies and physicians regarding utilization issues. 

• Utilizes important message from Medicare (IMM) when appropriate. 

• Ensures managed care reviews are up to date and accurately reflect patient's clinical progress and acute needs. 

• * Participates in the quality management of patient care outcomes.

• Submits data to management regarding case management and/or quality initiatives.

 • Participates in data collection regarding patient's length of stay, utilization of clinical resources, IPRO citations including appropriate recommendations and re-admission within 30 days. 

• * Initiates appropriate discharge planning as supported by initial assessment at time of admission 

• Reviews patient's chart. 

• Assesses each patient physically, psychosocially and financially.

 • Assesses patient's support system to facilitate appropriate discharge to community.

 • Substantiates, with the physician, the need for home care services. 

• Coordinates procurement of any supplies, equipment or home lab work needed by patient to evaluate discharge. 

• Arranges for post-hospital transportation, when indicated.

 • Interacts and coordinates with community agencies, families, vendors facilities and institutions to facilitate patient discharge. 

• * Documents the case management process in the medical record.

 • Completes and documents a psychosocial assessment on the patient. 

• Documents on-going processes of patients' hospitalization. 

• Documents finalized discharge plan and disposition. 

• Completes applicable areas of the Patients Discharge Instruction Sheet and the Patient Transfer Sheet.

 • Ensures Patient Review Instrument (PRI) is completed and reflects clinical profile of the patient. • Ensures case management sheet is current and accurate. 

• * Performs related duties, as required.

*ADA Essential Functions

Qualifications

• Bachelor's Degree in Nursing, required. 

• Current license to practice as a Registered Professional Nurse in New York State. 

• Case Management Certification, preferred. 

• Minimum of one (1) year related experience, required. Experience in case management and clinical pathways, variance analysis and trending, quality management/utilization review and home care/discharge planning, preferred. 

• Keeps abreast of developments in the field and serves as a resource to other staff.

Job Profile Requirements

LIC - NYS Registered Nurse (RNLIC) 

AND

 EDULVL - Bachelors Degree

*Additional Salary Detail
The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).