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:||$30,819.60-$64,813.80||Line Number:||Line# 56529|
|Additional Position Information: Hours of work : 9AM-5PM; Days of the week: Mon-Fri; Hours per week: 22.5. THIS IS A PART-TIME POSITION @ .60 FTE.|
Brief Description of Duties:
The Case Manager will report to the Supervisor of Case Management and provide critical assistance in discharge planning activities as well as provide clinical reviews to manage care payers and the medical team as appropriate. Complete initial clinical reviews daily and timely on all Managed Care patients. Perform initial/concurrent reviews using standard review criteria via (Milliman Care Guidelines) to determine medical necessity. Facilitate discharge planning and collaborate with social workers on appropriate teams. Attend and participate in daily team conferences. Communicate with multidisciplinary teams to ensure proper documentation that will enhance maximum reimbursement. Ensure appropriate documents that meet regulatory requirements are in the medical record eg: IMM forms, Observation notices. Ensure patients are placed in the proper level of care by communicating with the approriate physicians. Communicate with patient/family members appropriately and be cognizant of cultural facts that can affect hospital stay and discharge planning. Document delays or variances from expected length of stay in Morissey. Identify patients who are re-admitted within 30 days. Assess for actual/potential risks then confer concerns to medical team and appropriate social worker. Document interaction in patientsí medical records. Facilitate the peer-peer process with physicians for denied cases.
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.|
REQUIRED: Bachelorís degree in Nursing. Current NYS RN License. PRI and Case Management Certification. EXPERIENCE: Broad Clinical knowledge and experience. Minimum of three (3) years acute hospital and nursing care. Minimum of two (2) years in utilization review and case management. Minimum of one (1) year experience in discharge planning. Knowledge: Federal, State and TJC regulations. Medicare, Medicaid and Managed care standards requirements, reimbursement systems, benefits and benefits administration. Proficiency in use of PC, Microsoft Office Suite and Clinical Applications. Skills: Ability to work with diverse patient populations with knowledge and sensitivity to cultural and spiritual influences impacting on patient care. Possess a positive attitude, motivation and good interpersonal skills. Excellent verbal and written communication skills. Good problem resolution skills. Ability to work in a multidisciplinary-team approach. Ability to work independently with minimal supervision.
|Posting ID: 14339||Ref #: B/PR-56529-16|
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( 56529 ) and PostingID( 14339 )
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.