Mount Sinai Careers

Case Manager

New York, New York
Nursing


Job Description

Strength Through Diversity

Ground breaking science. Advancing medicine. Healing made personal.

 
Roles & Responsibilities:
  • Principle Duties and responsibilities include, but are not limited to:
  • 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.
  • Utilization Review:
  • 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.
  • Discharge Planning:
  • 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.
  • Collaborates and participates in the appeals process with all members of the interdisciplinary team.
  • Collaborative Relationships:
  • Develops and maintains effective working relationships with interdisciplinary team and
  • Case Managers within managed care organizations. Participates in nursing orientation.
  • Interfaces with other departments in the Medical Center. 

 

Requirements:
  • Education Requirements:

    Bachelor’s Degree in Nursing; Masters preferred. 

    Experience Requirements: 

    Previous experience as in homecare, long term care or utilization review preferred.
    Discharge Planner or Case Manager preferred.
    Manager or a minimum of 3-5 years’ experience as a RN in an acute care setting. 

    Licensing and Certification Requirements: 

    Current NYS RN nursing license. CCM certification preferred. Re-credentialing of CCM status expected. PRI Certification (to be obtained within 1 year) 

    Computer Skills:
     

    Microsoft Office   - Intermediate 

    General Skills and Competencies:
     
    • Ability to assess patient status
    • Ability to work independently and collaboratively with the interdisciplinary team,
    • patient/family, and others as appropriate. Ability to coordinate, prioritize and allocate resources
    • Ability to use basic data entry and retrieval systems.
 
Strength Through Diversity

The Mount Sinai Health System believes that diversity and inclusion 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 healthcare delivery together.
 
We work hard to recruit and retain the best people, and to create a welcoming, nurturing work environment where you have the opportunity and support to develop professionally. We share the belief that all employees, regardless of job title or expertise, have an impact on quality patient care. 

Explore more about this opportunity and how you can help us write a new chapter in our story! 

Who We Are

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 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 St. Luke’s, and New York Eye and Ear Infirmary of Mount Sinai.
 
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. 

EOE Minorities/Women/Disabled/Veterans
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