Plans and manages the administration, organization, human resources, training and supervision of all aspects of patient admissions, discharge management, utilization management for the Department from admissions through continuing stay, denials, and appeals. The Admitting Manager reports to the Administrator and works closely with the medical staff as it relates to census and utilization management.
Duties and Responsibilities
Directs, delegates and coordinates the daily operational activities in the admitting area and to increase and facilitate patient flow.
Monitors Quality Assurance controls while maximizing the number of patients admitted.
Acts as a Liaison with Physicians, nursing, counseling, financial, administrative and other hospital staff.
Prepares daily, weekly and, monthly statistical reports.
Assists with the training of new personnel, job evaluations, grievances procedures and the implementation of new policies and procedures.
In collaboration with the Administrator and inpatient leadership plans and implements strategies for overseeing the UM program.
Directs and guides UM Specialists, guides admissions and medical leadership on all aspects of Utilization Management in the provision of utilization management services.
Responsible for oversight of monitoring adherence to, and provision of training for effective insurance verification, pre-certification, and both in and out-of-network benefits.
Responsible for adherence to best practices with regard to UM optimization for transfer to in-network inpatient facilities and for out-of-network patients whenever clinically and practically possible – obtaining single case agreements as needed and possible.
Resolves problematic utilization and quality issues
Reviews and complies pertinent medical/discharge planning information to prepare appeals in order to ensure billing and receipt of payment to the hospital center.
Communicates issues impacting the Departmental Operations to the Administrator, Managers, and Medical Leadership responsible for the affected units.
Responsible for all aspects of oversight of the initial and concurrent review program.
Participates and assists in the development of departmental programs to enhance UM and denial/appeals in relationship to job performance and productivity.
Contributes to establishing and develops department and procedures to maintain uniformity, standardization, quality services and compliance with hospital and regulatory standards.
Provides in-service training for multi-disciplinary staff to enhance knowledge and expertise in utilization management.
Interviews, and in collaboration with the Administrator and key department management, recommends selection of insurance specialists
Provides single point of access on matters pertaining to Utilization Management for the department
Supervises and manages all Utilization Management staff
Coordinates outside UM related service and vendors in collaboration with the Administrator. Responsible for timely submission of invoices and contractor services pertaining to Utilization Management vendors and contractors.
Responsible for ongoing revenue recovery, production tracking and reporting
This position meets with the Administrator, Inpatient leadership and admissions leadership regularly, establishes scheduled staff meetings and provides ongoing supervision to all utilization management staff; attends monthly Denials Management Meeting.
Collects and analyzes data; develops reports and presentations; manages surveys and studies as indicated and required by management
Master level degree in related clinical field.
Minimum of 7 years clinical/administrative experience with strong organizational, analytical and communication skills.
Microsoft Office - Intermediate
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.