ANNOUNCEMENT OF Professional Vacancy

STATE UNIVERSITY OF NEW YORK · DOWNSTATE MEDICAL CENTER  
450 CLARKSON AVENUE, BOX 1194, BROOKLYN, NEW YORK 11203
Department: CARE MANAGEMENT Job Title: TH UTIL REV AND QA SR COORD
Professional  Rank: SL-4 Descriptive Title: CASE MANAGER
Salary Range: $51,366.00-$108,023.00+$3,026.00* Line Number: Line# 56439
Additional Position Information: * Represents Location Pay for full-time appointees.Hours of work: 8:00AM - 4:00PM; Days of the week: Variable: Hours per week: 37.5
Brief Description of Duties:
The Case Manager will provide hospital case management, utilization review and discharge planning to ensure that the patient progresses through the continuum of care and is discharged through a well-coordinated transition of care plan. Utilized standard review criteria, specifically the Milliman Care Guidelines, to justify level of care, medical necessity, expected length of stay, and intensity for inpatient admissions; Review, plans and facilitates all aspects of the patient's care planning, including care coordination, utilization review and discharge planning. Perform initial clinical review and continued care review for all hospitalized patients using standardized care guidelines to determine medical necessity for inpatient admission or for placement in other appropriate level of care; Promote interdisciplinary collaboration; Provide resources to the Interdisciplinary team when appropriate on issues of medical necessity and clinical documentation requirements; Collaborate with Social Worker, the Department of Nursing and physician to discuss patient treatment plan and transition of care post-hospitalization; Facilitate concurrent requests for reconsideration of potential denial; Coordinate peer interaction between SUNY UHB physicians and the managed care organizationís physicians to prevent denial of reimbursements; Complete Patient Review Instrument (PRI) as mandated by New York State for patients being discharged to a Skilled Nursing Facility, Sub-acute Rehab or Nursing Home; Address the denial of cases within the assigned unit and provide written appeal that will have a positive impact on final reimbursement decisions by payers; Support the initiatives, programs, process improvements and problem resolutions implemented by the Care Management department.

DUTIES AND RESPONSIBILITIES ARE NOT LIMITED TO THE ABOVE POSITION DESCRIPTION

All successful candidates must undergo various background checks, maintain credentials required for continued employment and adhere to the SUNY-DMC UHB Principles of Behavior.   Clinical Faculty and Allied Health professionals must receive and maintain Medical Board authorization.
Qualifications:
REQUIRED: Bachelor's degree in Nursing. Patient Review Instrument Certification; New York State RN License; A minimum of 3 years direct patient care experience; A minimum of 2 years Case Management or Utilization Review Management experience; A minimum of 2 years Discharge Planning experience. PREFERRED: Experience in Denials and Appeals, Clinical Documentation Improvement and Disease Management.
Posting ID: 15034 Ref #: B/PR-56439-17
Persons interested in the above position should submit a resume along with a cover letter to ==>
Please include: Job Title( TH UTIL REV AND QA SR COORD ), Line( 56439 ) and PostingID( 15034 )
The Employment Office
M.S.C.  1194
450 Clarkson Avenue
Brooklyn, New York 11203  ( email: careers@downstate.edu )

Closing date for receipt of applications:

Internal Consideration Program: Open Until Filled Off-campus recruitment: Open Until Filled

SUNY Downstate Medical Center offers a competitive salary and benefits package.
SUNY Downstate Medical Center is an affirmative action, equal opportunity employer and does not discriminate on the basis of race, color, national origin, religion, creed, age, disability, sex, gender identity, sexual orientation, familiar status, pregnancy, predisposing genetic characteristics, military status, domestic violence victim status or criminal conviction.