The Mount Sinai Health System
Do you have what it takes to wear the badge?
The Mount Sinai Health System’s commitment to excellence extends beyond delivering world-class health care. The System’s ongoing success is dependent upon our highly motivated, nonclinical professionals working to improve business operations. Our leadership team is driven to provide exceptional service by cultivating a workforce that is dedicated to upholding Mount Sinai’s mission of delivering innovative, breakthrough medicine with compassion and integrity.
Are you ready to discover the world of limitless possibilities that comes with wearing the badge? Explore more about this opportunity and how you can help us write a new chapter in our story of unrivaled patient care!
What You’ll Do:
The Director will direct and manage departmental activities involved in utilization review, appeals management and discharge planning to facilitate the case management process and maximize reimbursement to the hospital. Must be able to navigate through a wide variety of managed care contractual issues.
1. Reviews department clinical services and operations, and tracks case management activity. Identifies areas for performance improvement by examining productivity and workload within each department. Directs, coaches, mentors and assesses staff in clinical case management service delivery.
2. Oversees activities of onsite Care Managers.
3. Develops relationships and seeks feedback from internal and external 5stakeholders regarding the implementation of department activities to garner satisfactory customer results.
4. Emphasizes a collaborative approach and seeks to influence other services by focusing on patient processes.
5. Develops and implements Utilization Review (UR) based on internal data collection, data received from external agencies, Physician Advisors and the Medical Director.
6. Ensures Discharge Appeals functions are carried out within contractual, federal and state guidelines. Presents and reviews data relative to avoidable days, denials, length of stay and other key metrics to leadership.
7. Maintains necessary levels of staff qualifications, competencies, staffing levels (hiring and discharge), regulatory compliance, individual development plans, continuing education and performance appraisal.
8. Works collaboratively with Admitting, Transfer Services and Finance to ensure appropriateness of admissions and proper reimbursement.
What You’ll Bring:
BSN in Nursing; Masters preferred
5 years case management and 6 years as clinical nurse. Previous supervisory experience in care management or related field.
Certification in care management is preferred Individual must possess strong leadership, case management, organizational, analytical, negotiation and conflict
management skills. Individual must have the ability to provide innovative leadership in a dynamic environment and be able to work collaboratively, with a hands-on approach to management as well as the ability to keep strategic initiatives in focus.
Do you share our dedication to extraordinary service and have what it takes to wear the badge? Apply now!
Who We Are:
Over 35,000 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 hospital campuses, including Mount Sinai Beth Israel, Mount Sinai Beth Israel Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai West (formerly Mount Sinai Roosevelt), Mount Sinai St. Luke’s, and New York Eye and Ear Infirmary of Mount Sinai.
The Mount Sinai Health System is committed to the tenets of diversity and workforce that are strengthened by the inclusion of and respect for our differences. We offer our employees a highly competitive compensation and benefits package, a 403(b) retirement plan, and much more.
The Mount Sinai Health System is an equal opportunity employer. We promote recognition and respect for individual and cultural differences, and we work to make our employees feel valued and appreciated, whatever their race, gender, background, or sexual orientation.