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
    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.
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