Ground breaking science. Advancing medicine. Healing made personal.
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 stakeholders 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.
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.
The Mount Sinai Health System believes that diversity is a driver for excellence. We share a common devotion to delivering exceptional patient care. Yet we’re as diverse as the city we call home- culturally, ethically, in outlook and lifestyle. 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 work hard to acquire and retain the best people, and to create a welcoming, nurturing work environment where you can develop professionally. We share the belief that all employees, regardless of job title or expertise, can make an impact on quality patient care.
Explore more about this opportunity and how you can help us write a new chapter in our story!
Over 38,000 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 an equal opportunity employer. We comply with applicable Federal civil rights laws and does not discriminate, exclude, or treat people differently on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, or gender expression.