Department : Care Management

Job Schedule : Full Time

Shift : Day

Hours: M-F 8A-4Por 9A-5P W/weekend rotation

Salary Range: $105,216- $145,113

Sign On Bonus : $5,000

Position Summary:

• Perform the initial comprehensive assessment upon admission following the Care Management Department policy.
• Screen all patients using established tools for high-risk indicators (AIMS, Geisinger, polypharmacy) to ensure appropriate supportive services for high-risk patient populations to prevent readmission.
• Assess all patient populations for potential discharge planning needs.
• Continuously reassess patient needs throughout their hospital stay.
• Engage in Utilization Review (UR) activities in accordance with department policies.

Essential Functions and Responsibilities Includes the Following:

• Understands and adheres to the WPH Performance Standards, Policies and Behaviors
• Completes a comprehensive initial assessment.
• Performs all activities for multidisciplinary care coordination at the intra-hospital level of care and inter-hospital level of care.
• Performs all transitional planning activities including but not limited to:
  a.Patient/caregiver education
  b.Arrangement of all aftercare
  c.Commercial payer involvement
  d.High utilizer patient root cause
• Communicates and collaborates all relevant patient information to appropriate health team members.
• Ensures department goals of LOS reduction, readmission prevention, denial reduction, and satisfaction improvement are realized.
• Documents per department requirements.
• Participates in Performance Improvement activities as needed.
• Performs all UR activities per department policy:
  a.Commercial payer reviews
  b.Disposition determination
  c.Retro/self-audit
  d.MC variance
• Admission clinical review.
• Performs all other related duties as assigned

Education & Experience Requirements

• BSN or related Bachelor's degree required
• 5 years clinical ED, critical care or med/surg experience required
• Previous case management experience preferred
• Knowledge of healthcare financial, regulatory, and payer issues preferred
• Knowledge of state, local, and federal programs strongly preferred
• Experience in use of Milliman/InterQual criteria
• Registered Nurse (RN) NYS license required
• PRI/Screen certification strongly preferred.
• C.C.M. (Certified Case Manager) certification preferred
• Computer skills essential

Core Competencies

• Demonstrates ability to establish two-way communication by clearly defining expectations, communicating utilizing a variety of methods, actively listening to ideas and concerns and responding in an appropriate manner.
• Demonstrates ability to delegate responsibilities appropriately.
• Demonstrates ability to retain composure under stress and perform multitasking functions.