Mount Sinai Medical Center New York , NY 10007
Posted 2 months ago
Strength Through Diversity
Ground breaking science. Advancing medicine. Healing made personal.
Roles & Responsibilities:
Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve optimal patient outcomes and appropriate reimbursement for the organization.
Performs continued stay reviews utilizing standardized criteria to justify continued inpatient stay.
Collaborates with Physician and other clinicians to expedite diagnostic testing, treatment and consultations.
Documents all clinical reviews in Canopy.
Supports the mission, vision, philosophy and goals of the Medical Center.
Promotes an environment that is sensitive to cultural diversity and is open and responsive to the diverse backgrounds and experience of others.
Case Management: The CM process will include:
Assessment of the patient's clinical, psychosocial, and functional status in collaboration with the interdisciplinary team.
Identification and documentation of variances affecting the LOS and the discharge planning process.
Conducts follow-up of any delays in treatment or reporting of results.
Planning/developing specific goals with the physician, interdisciplinary team, and the patient and/or family.
Implementation and coordination of specific activities, strategies, and interventions to move the patient through the continuum of care.
Documentation of outcomes achieved and identified internal and external barriers.
Identifies reasons for readmissions and collaborates with interdisciplinary team on strategies to reduce readmission rate.
Appropriately identifies and refers cases to the physician advisor to support timely progression of patients along the continuum of care and (appropriate) discharge planning.
Interacts with patient/family to discuss plan of care and coordination of services based on clinical needs and available resources.
Maintains a working knowledge of the UR requirements of each payor within the patient population;
Provides the clinical information requested by the managed care companies as part of the concurrent review in a timely fashion.
Provides clinical information requested by the managed care companies in accordance with contractual agreements.
Works collaboratively with physicians and managed care companies on concurrent denial appeals
Communicates clinical information to the payor, as needed, coordinating direct communication between physician and payor Medical Director as required.
In psychiatry, the CM will document UR notes in the medical record as per OMH guidelines.
Responsible for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission).
Obtains authorizations from managed care companies for post-discharge services.
Assesses for clinical readiness and completes the Hospital and Community Patient Review Instrument (PRI) for patients requiring Residential Health Care Facility placement.
Liaison with financial department for current insurance coverage.
Bachelor's Degree in Nursing; Masters preferred.
Previous experience as in homecare, long term care or utilization review preferred.
Case Manager experience
Current NYS RN nursing license.
CCM certification preferred. Re-credentialing of CCM status expected.
PRI Certification (to be obtained within 1 year)
BCLS from AHA
Strength Through Diversity
The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you become a part of Mount Sinai's unrivaled record of achievement, education, and advancement as we revolutionize medicine together. We invite you to participate actively as a part of the Mount Sinai Health System team by:
We work hard to acquire and retain the best people and to create an inclusive, welcoming and nurturing work environment where all feel they are valued, belong, and are able to professionally advance. We share the belief that all employees, regardless of job title or expertise, contribute to the patient experience and quality of patient care.
Explore more about this opportunity and how you can help us write a new chapter in our history!
Who We Are
Over 42,000 employees strong, the mission of the Mount Sinai Health System is to provide compassionate patient care with seamless coordination and to advance medicine through unrivaled education, research, and outreach in the many diverse communities we serve.
Formed in September 2013, The Mount Sinai Health System combines the excellence of the Icahn School of Medicine at Mount Sinai with seven premier hospitals, including Mount Sinai Beth Israel, Mount Sinai Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai West (formerly Mount Sinai Roosevelt), Mount Sinai Morningside ( Formerly St Luke's), and New York Eye and Ear Infirmary of Mount Sinai.
The Mount Sinai Health System (MSHS) provides equal employment opportunity to all its employees and applicants for employment without unlawful discrimination on the basis of their actual or perceived race, creed, color, religion, national origin, sex, gender, gender expression, gender identity, age, disability, marital or parental status, sexual orientation, veteran, immigration, citizenship, or other protected status.
EOE including Veterans and Disabled
The Mount Sinai Health System (MSHS) provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $69.39 - $69.39 Hourly. Actual salaries depend on a variety of factors, including experience, 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.
Mount Sinai Medical Center