Care Manager (RN)
Company: NYU Langone Health
Location: New York
Posted on: October 14, 2024
Job Description:
is a world-class, patient-centered, integrated academic medical
center, known for its excellence in clinical care, research, and
education. It comprises more than 200 locations throughout the New
York area, including , , and a level 1 trauma center. Also part of
NYU Langone Health is the , a National Cancer Institute designated
comprehensive cancer center, and , which since 1841 has trained
thousands of physicians and scientists who have helped to shape the
course of medical history. At NYU Langone Health, equity,
diversity, and inclusion are fundamental values. We strive to be a
place where our exceptionally talented faculty, staff, and students
of all identities can thrive. We embrace diversity, inclusion, and
individual skills, ideas, and knowledge. For more information, go
to -, and interact with us on -, -, -, -, -, - -and -.Position
Summary:
We have an exciting opportunity to join our team as a Care Manager
(RN).
In this role, the successful candidate Coordinates, negotiates,
procures, and manages the care of patients by providing focused
care coordination across the acute care continuum. Evaluates
appropriate clinical resource utilization, and assesses patients
for transitioning to the next appropriate level of care through
review of patient records and information derived from
interdisciplinary rounds. Collaborates with the health care team to
ensure the achievement of quality outcomes for patients/familiesJob
Responsibilities:
- Identifies cases that require peer review in accordance with
the clinical indicators and criteria developed by the clinical
department. Identifies trends in care, processes or services that
may provide opportunities for improvement in a patient population
or clinical service. Refers appropriately cases that require peer
review in accordance with the clinical indicators and criteria
developed by the clinical department. Takes initiative to
participate in a quality/process improvement initiative.
Collaborates with the interdisciplinary team to create solutions
and take corrective actions to address issues resulting in
variances in the plan of care.
- Applies customary protocols, pathways, evidence-based processes
and other means of managing patient care. Utilizes protocols,
pathways and order sets to formulate, communicate and ensure
implementation of the patient plan of care. Utilizes
multidisciplinary team to address individualized patient needs.
Develops realistic goals with multidisciplinary team for patient to
achieve milestone activities within appropriate timeframes.
Demonstrates flexibility with plan of care to meet patient
needs..
- Supports the mission, philosophy, standards, goals and
objectives of NYU Hospitals Center and Care Management Program.
Contributes to the development of the goals and objectives of the
Care Management Program consistent with the objectives of NYU
Hospitals Center. Understands, applies and supports
departmental/hospital policies, procedures and standards. Observes
at all times legal and ethical considerations pertaining to
patients and hospital personnel. Initiates programs for improving
cost effectiveness in coordination of patient care. Assists
managers to create a participative environment in department based
meetings and other activities. Analyzes and develops systems to
improve processes and outcomes in collaboration with managers.
- Communicates the outcome of chart review and managed care
company telephonic review with the health care team as appropriate.
Conducts accurate reviews using CMS, Milliman Care Guidelines and
the patients chart as the primary source of information. Performs
and documents initial certification and continued stay reviews
within appropriate time frame and in appropriate system. Documents
obtained payor authorization in a complete, timely and concise
manner. Maintains follow-up communication with payor as required
for authorization of hospital stay. Notifies health care team of
outcomes of communication with payor and authorization status.
Notifies departmental manager of all unresolved utilization
problems/issues.
- Acts as advocate/facilitator in all cases with insurance
related issues, delays in treatments and/or diagnostic tests.
Collaborates with the interdisciplinary team to maintain
appropriate levels of care to facilitate movement of the patient
through the continuum. Identifies and documents delays in treatment
and processes. Understands basic reimbursement systems and
identifies potential payor issues relative to delays in treatments
and/or diagnostic tests. Assists in developing strategies to
decrease avoidable days. Demonstrates and communicates the value of
avoidable days and/or additional documentation to justify acute
inpatient hospitalization.
- Participates in departmental, interdisciplinary, hospital and
Medical Board committees as appropriate. Participates in
departmental, interdisciplinary, hospital and Medical Board
committees as requested. Represents the voice of Care Management in
committee participation. Completes committee assignments as
requested. Provides feedback and periodic reports to Care
Management at departmental meetings and senior managers on relevant
issues.
- Assesses patient and medical record documentation for
appropriate acute admission and level of care, quality and safety
indicators, and plans for discharge. Assesses patient and medical
record documentation to identify medical necessity and
appropriateness of admission and continued stay using
pre-established clinical criteria (i.e., Milliman Care Guidelines,
CMS) according to hospital policy. Ensures that the physicians
documentation supports level of care. Collaborates with physician
when additional documentation needed to support level of care.
Communicates appropriate level of care to the health care team.
Utilizes patient assessment information to identify quality and
safety indicators to monitor during hospital stay. Performs initial
and ongoing assessment of patient/family needs for discharge
planning and communicates findings to interdisciplinary team.
- Performs systematic assessment and reassessment of patient and
family/significant other considering clinical presentation,
cultural and religious influences, individual experiences,
available resources, environmental factors as well as health
behaviors and practices. Considers all aspects of patient/family
assessment findings. Understands medical plan of care and is able
to communicate pertinent findings from patient assessment. Monitors
medical plan of care to determine outcome of treatment and revise
patient assessment as necessary. Facilitates appropriate consults
based on patient assessment to ensure timely delivery of care.
Identifies cultural and religious influences on illness.
- Formulates the plan of care, along with the patient and family,
based on communication with the attending physician(s), expected
goals of care and length of stay; articulates knowledge of the plan
of care through an understanding of patients diagnosis, prognosis,
care needs, and desired outcomes. Considers assessment findings and
collaborates with the attending physician (s)/hospitalist to
establish the expected goals of care and LOS. Collaboratively
participates in the development of an interdisciplinary plan of
care that is individualized to the patients condition or needs.
Focuses the care plan on quality of life, effective utilization of
resources, and facilitates goal achievement and movement through
the continuum of care. Proactively identifies hospital services and
available resources to meet patients needs. Reviews patient history
and re-assess prognosis and care needs to achieve desired outcomes.
Assesses patient/family needs for advance care planning. Confers
with attending physician/hospitalist and health care team regarding
variances from anticipated plan of care.
- Works collaboratively with attending physician, consulting
physician(s) and other disciplines to identify, develop, implement
and coordinate an appropriate plan of care that maximizes
individual patient/family preference and enhances quality, access,
and cost-effective outcomes. Ensures patients individualized plan
of care is collaborative and multidisciplinary by working with
patient/family, attending physician/hospitalist and health care
team members. Coordinates care based on individual needs, expected
goals and length of stay. Facilitates interdisciplinary plan of
care interventions. Communicates effectively with attending
physician/hospitalist and members of health care team to enhance
patient care in a positive environment.
- Assesses patient and family responses to interdisciplinary plan
of care and care management interventions, and adapts interventions
to achieve optimal outcomes. Collaborates with patient, family,
interdisciplinary team for agreement with treatment goals,
timeframes and coordination of care. Works with the
interdisciplinary team to facilitate adjustments to the care plan
to promote enhanced outcomes. Intervenes as care manager in a
manner that is consistent with the established plan of care.
Prioritizes and organizes interventions. Implements interventions
in a safe, timely and appropriate manner.
- Documents assessments, findings, progress, interventions and
recommendations in a care management software system and/or medical
record according to established standards. Documentation meets
standards in accordance with departmental and hospital policy and
procedures. Documents assessments, findings, progress,
interventions and recommendations in Canopy and ECIN Care
Management and ICIS systems within established timeframes.
Documents revisions in diagnoses, plan of care and outcomes.
Documents patients responses to interventions with appropriate
consideration of patient confidentiality.
- Contributes to the development of new strategies to address
transitional planning needs of specific assigned patient
populations, improved care coordination and care management
delivery. Utilizes current literature to facilitate clinical/care
management practice changes. Participates in the development and
revision of clinical/care management practice standards. Engages in
strategies to measure improvements in quality of care that directly
result from care management interventions. Utilizes evaluative and
outcomes data to improve care management services.
- Participates in development of quality indicators and analysis
of such indicators per departmental quality & performance
improvement plan. Collaborates with members of the
interdisciplinary team to develop quality indicators to measure
performance improvement per departmental quality & performance
improvement plan. Conducts required and initiated monitoring
activities report to respective disciplines as indicated. Evaluates
outcomes of monitoring, and adjusts targets and reporting as
indicated. Facilitates and ensures sharing of data and outcomes
with interdisciplinary team.
- Uses evidence-based practice to drive improvement strategies.
Promotes health care outcomes in conjunction with evidence-based
guidelines. Identifies areas requiring further study. Develops
strategies to utilize data findings for individual patients as well
as program. Recommends interdisciplinary evidence-based practice
changes.
- Facilitates effective coordination of interdisciplinary
unit/physician team (e.g., Firm on the Medical Service) rounds to
identify the patients clinical management needs, progression of
care, identification of barriers, appropriate discharge plan and
anticipated discharge date. Assumes a leadership role to coordinate
and facilitate daily interdisciplinary unit/physician team rounds,
LOS management and discharge process. Collaborates with the
interdisciplinary team to maintain appropriate levels of care to
expedite the movement of the patient to alternate levels of care
throughout the continuum. Reviews, monitors and individualizes on
an ongoing basis, each patients plan of care based on diagnosis and
assessment of patient/family needs. Identifies internal obstacles
to efficiency and good patient outcomes and intervenes with
healthcare team to eliminate when possible. Identifies a follow-up
time frame to accomplish the recommended plan. Communicates patient
status and needs to the next level of care for discharge
planning.
- Facilitates timely and appropriate communication among
attending physicians, nurse practitioners, physician assistants,
patients, family members, other members of the health care team,
external providers and payers. Refers significant clinical issues
per protocol to the attending physician and/or hospitalist or to
the designated consultants. Utilizes chief of service/physician
advisor to address unresolved clinical and interdisciplinary
issues. Participates and contributes as a regular member of
interdisciplinary rounds to communicate and receive pertinent
information. Utilizes critical thinking skills and assists others
to identify and resolve potential and existing problems related to
coordination of patient care. Determines the best method to
communicate with the interdisciplinary team about different kinds
of issues (i.e., direct contact, telephoning, emailing, and
paging). Collaborates with attending physician/hospitalist
regarding patients achievement of therapeutic regimen.
- Ensures identification of variances and the development of
appropriate contingency plans for each phase of care in the event
of patient health complications or systems barriers. Communicates
with the attending physician/hospitalist, patient/family and staff
regarding alteration in plan. Monitors test results, patient
responses to interventions, health status and makes recommendations
for revisions to treatment plan based on patient need and
responses. Evaluates and communicates changes in patients clinical
condition timely. Documents medical plan of care and reflects
patients progress in meeting prescribed plan.
- Effectively communicates information relative to a potential
denial to the appropriate members of the health care team.
Communicates timely, complete, and accurate information relative to
a potential denial to the appropriate members of the health care
team. Demonstrates an understanding of the peer-to-peer appeal
process for authorization of acute inpatient hospitalization.
Effectively monitors, documents and informs members of the health
care team the outcome of the peer-to-peer appeal process.
Demonstrates an understanding of CMS, Milliman Care Guidelines
relative to the patients diagnosis and condition when providing a
clinical review to the payor to prevent a potential denial.
Effectively communicates the impact on reimbursement to the
hospital for potentially denied days to the health care team.
Utilizes the chief of service/physician advisor per departmental
guidelines.
- Coordinates discharge appeals or issuance of Hospital Notices
in accordance with State and Federal Regulations and departmental
guidelines. Demonstrates an understanding of the CMS and NY State
regulations for discharge appeals and issuance of Hospital Notices.
Follows procedures for issuing Hospital Notices when appropriate
and communicate necessary information to healthcare team relative
to patients benefits. Facilitates issuance of the Important Message
from Medicare within 24 48 hours before discharge and the Detailed
Notice of Discharge if indicated. Effectively communicates the
initiation of a discharge appeal to the health care team.
Coordinates the collection of medical record documentation for
review by the review agent (i.e., IPRO, managed care carrier).
Communicates outcome of discharge appeal to patient/family and
health care team.
- Educates nursing, medical and ancillary staff about care
management role, relevant clinical criteria and resources available
for patients, as well as regulatory and managed care requirements.
Demonstrates an understanding of the vision and goals of the care
management program. Demonstrates an understanding of the core
functions of the care management role. Demonstrates an
understanding of and effectively communicates information relative
to clinical criteria and resources available for patients/families
to the healthcare team. Serves as a resource for other members of
the health care team by participating in or conducting
formal/informal in-service education as needed. Identifies own
practice abilities and limitations and obtains instruction and
supervision as necessary. This includes seeking education for self
development.
- Facilitates patient/family knowledge of and participation in
the plan of care. Identifies long and short term needs based on a
comprehensive assessment and anticipate outcomes. Proactively
identifies hospital services and available resources to meet the
patients needs. Ensures that patients individualized plan of care
is collaborative and multidisciplinary by working with patient,
physician, and health care team members. Focuses the care plan on
quality of life, effective utilization of resources, and
facilitates goal achievement and movement through the continuum of
care. Collaborates with patient/family, physician, and health care
team for final agreement with treatment goals, timeframes and
coordination of care. Develops additional and contingency plan
options with patient/family when planning for discharge.
- Participates in development and implementation of appropriate
patient/family education material pertinent to population served.
Contributes to the development of patient/family education material
for disease management. Facilitates patient/family education and
understanding to prevent risk behaviors and to promote and achieve
good health outcomes. Educates the patient/family and provide
support in moving toward self-care. Educates and assists in
facilitating patient/family access to necessary and appropriate
health care services.
- Maintains current clinical knowledge in area of review and
patient population. Achieves and maintains current professional
licensure, national certification, and/or higher education in case
management or in a health and human services profession directly
related to case management practice. Maintains continuing
competence appropriate to case management and to professional
licensure or professional certification. Provides only case
management services within scope of practice. Refers patient to
another source for services outside scope of practice. Maintains
continuing competence appropriate to case management and to
professional licensure or professional certification. Maintains
annual mandatory education requirements. Maintains membership in
professional organizations.
- Promotes own professional growth and development in care
management role. Identifies own practice abilities and limitations
and obtains instruction and supervision as necessary. This includes
seeking education for self development. Participates in and
utilizes peer review to identify areas for improvement in practice
and leadership. Achieves previously established personal
professional goals. Participates in departmental education
sessions.
- Evaluates appropriateness of alternate level of care for
optimal delivery of services to the patient and for resource
efficiency. Assesses the need for continued acute care services.
Anticipates barriers to discharge. Assesses and re-assesses
appropriate discharge plans and options based on clinical need and
patient/family resources. Collaborates with other members of the
interdisciplinary team to dual plan discharge options. Facilitates
patient/family team meetings to discuss discharge plan and
options.
- Communicates information documented in the medical record that
identifies a potential event/occurrence to the Risk Manager.
Identifies quality and risk management issues; refer issues for
corrective action as appropriate. Documents a potential
event/occurrence and communications to the Risk Manager into Canopy
within established timeframes.
- Serves as resource for education of patients, families, peers,
staff and physicians. Facilitates patient/family teaching as soon
as learning needs are identified. Provides patient/family education
regarding post acute services, community resources or other as
needs identified. Role models expert professional care management
practices. Supports a constructive environment of learning and
development of mutual respect with health care team and peers.
Facilitates staff access to outside educational opportunities
through sharing of program announcements, etc.Minimum
Qualifications:
To qualify you must have a Professional Registered Nurse in New
York State with current registration.
Education: BSN required, or graduate of an accredited RN program
with BS in related health care field.
Experience: Three to five years clinical experience, acute
medical-surgical preferred, or in the care of the population to be
care-managed.
Competencies: Evidence of excellent interpersonal skills, effective
communication, negotiation and conflict management skills; creative
problem solving and clinical leadership; change management,
organizational and time management skills. Ability to apply
critical thinking and clinical expertise toward achievement of
specific outcomes. Previously demonstrated ability to foster strong
collaboration with co-workers, peers, physicians, nursing, and
ancillary departmental support staff. Knowledge of Microsoft Office
and demonstrated proficiency in managing software such as Eclipsys
Sunrise Manager, Canopy, and ECIN.
Required Licenses: Registered Nurse License-NYS, Basic Life Support
CertQualified candidates must be able to effectively communicate
with all levels of the organization.
NYU Langone Health provides its staff with far more than just a
place to work. Rather, we are an institution you can be proud of,
an institution where you'll feel good about devoting your time and
your talents.
NYU Langone Health is an equal opportunity and affirmative action
employer committed to diversity and inclusion in all aspects of
recruiting and employment. All qualified individuals are encouraged
to apply and will receive consideration without regard to race,
color, gender, gender identity or expression, sex, sexual
orientation, transgender status, gender dysphoria, national origin,
age, religion, disability, military and veteran status, marital or
parental status, citizenship status, genetic information or any
other factor which cannot lawfully be used as a basis for an
employment decision. We require applications to be completed
online.
If you wish to view NYU Langone Health's EEO policies, please .
Please to view the Federal "EEO is the law" poster or visit for
more information.NYU Langone Health provides a salary range to
comply with the New York state Law on Salary Transparency in Job
Advertisements. The salary range for the role is $118,613.99 -
$118,614.00 Annually. Actual salaries depend on a variety of
factors, including experience, specialty, education, and hospital
need. The salary range or contractual rate listed does not include
bonuses/incentive, differential pay or other forms of compensation
or benefits.To view the Pay Transparency Notice, please
Keywords: NYU Langone Health, Bristol , Care Manager (RN), Executive , New York, Connecticut
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