Accountable Care Manager - Case Management Program - Nyc Health Hospitals : Job Details

NYC Health + Hospitals/Bellevue is America's oldest public hospital, established in 1736. Affiliated with the NYU School of Medicine, the 844-bed hospital is a major referral center for highly complex cases, with its 6,000 employees including highly skilled, interdisciplinary clinical staff. It sees more than 110,000 emergency room visits and 500,000 outpatient visits annually. Bellevue is an academic medical institution of international renown. We have served as an incubator for major innovations in public health, medical science, and medical education. Bellevue is a Level I Trauma Center delivering around-the-clock care in adult, pediatric, psychiatric and pediatric psychiatric emergencies as well as in the nationally-designated categories of cardiology, neurology, toxicology, and neonatology. In addition to providing comprehensive inpatient and outpatient state-of-the-art care Bellevue is a city-wide medical specialty referral source. Bellevue's clinical centers of excellence include: Emergency Medicine and Trauma Care; Cardiovascular Services; Designated Regional Perinatal Center and Neonatal Intensive Care Unit (ICU); Comprehensive Children's Psychiatric Emergency Program; and Cancer Services. At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.Job DescriptionInterdisciplinary Rounds- Ensures a thorough, expedited hospital stay1. Assesses patients to identify needs, issues, resources and health care goals.2. Coordinates multidisciplinary rounds, reviewing and discussing:•Plan of careLevel of care (ex: ALOC, Observation)•Estimated length of stay/ Expected Discharge Date (EDD)•Need for continued hospitalization•Consultations/Testing/Procedures•Appropriateness of resource utilization Discharge plan.•Discharge barriers and resolutionUtilization Management1. Reviews all assigned cases, ensures documentation in the medical record supports plan of care and justifies admission and continued stay.2. Coordinates with finance for insurance verification3. Completes admission and continued stay reviews using MCG/IQ criteria, leading to optimal reimbursement4. Discusses cases with primary physician when medical record does not meet medical necessity to obtain additional supporting documentation.5. Reviews and discusses level of care with primary physician to ensure accuracy of the level of care determination with appropriate billing indicators (ex: Observation, ALOC) 6. Responds to requests for clinical information in a timely manner (within 24 hours or next businessday)7. Acts upon concurrent denials, facilitates MD to MD review/ case conference8. Closes cases appropriately. Provides discharge date/discharge review to managed care company.9. . Completes other duties as directedMinimum Qualifications1. Valid New York State license and current registration to practice as a Registered Professional Nurse issued by the New York State Education Department (NYSED); and2. A Baccalaureate degree in Nursing or related health field from an accredited college or university; and3. Holds, or obtains through facility orientation, a valid and current certification in Basic Life Support (BLS) through the American Heart Association (AHA); and4. Two (2) years of experience as a Registered Professional Nurse.NYC Health and Hospitals offers a competitive benefits package that includes:Comprehensive Health Benefits for employees hired to work 20+ hrs. per weekRetirement Savings and Pension PlansLoan Forgiveness Programs for eligible employeesPaid Holidays and Vacation in accordance with employees' Collectively bargained contractsCollege tuition discounts and professional development opportunitiesMultiple employee discounts programs