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.

DirectShifts is an Equal Opportunity Employer
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status, or any other characteristic protected by law.

Your Right to Work
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

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