Case Management Nurse

One Brooklyn Health Brooklyn, NY 11213, US

Overview

The role of the Case Management Nurse coordinates and directs the patient care case management strategies to ensure quality care and efficient use of resources. Provides for staff management and leadership in departmental planning and policy development.

Responsibilities

Assists in the development of the clinical pathways for assigned DRG’s in cooperation with medical and nursing staff.
Reviews the management of care by all care givers against the clinical pathway. Identifies, documents variances and determines justification and appropriateness of same. Takes appropriate action.
Conducts care management reviews effectively and takes appropriate action for all deviations that neither do nor meet criteria/or without justification.
Screens for quality, appropriateness and practitioner performance, using pre-established criteria. Makes appropriate referrals.
Conducts focused reviews as assigned. Prepares and submits timely and accurate reports on same assigned.
Actively participates in multi-disciplinary conferences for patients with special needs/problems. Provides information such as DRG LOS to other disciplines for timely discharge planning.
Provides timely clinical reviews to Third party Payers utilizing Milliman guidelines and Interqual criteria.
Coordinates the discharge appeal process accurately and timely when applicable.
Serves as resource/consultant to clinical departments regarding case management issues of policies.
Notifies Physician Advisors of need for review.
Prepares and presents accurate reports and serves on committees assigned.
Participates in the evaluation of UR, Discharge Planning, and QA programs annually and assists in strategic planning activities for the department.
Conduct orientation and in-service programs for topics related to the department on a unit level.
Collects QA data relative to the physician credentialing/re-appointment process. Collects data for employees practices patterns and refer same to appropriate department.
Recommend policies/procedures/standards/for the department.
Supervises proper level of care assignment.
Completes and submits ALC notices, PRI’s, HINN’s and reinstatement notices, accurately and timely as indicated.
Maintains competency through attending seminars, regarding job related topics.
Performs other duties as required.

Qualifications

Position Requirements:

Minimum BSN in Nursing degree required.
Current NYS Registered Nurse licensure.
Minimum of three (3) years clinical experience in an acute care setting. Critical care experience preferred.
Minimum of three (3) years prior Utilization Review/Case Management/Discharge. Planning/Quality Planning experience a must.
PRI certification required.
Knowledge and experience in utilizing MCG and Interqual criteria a must.

Language Skills:

Ability to communicate effectively in English both verbally and in writing.

Skills:

Knowledge of Federal, State and JCAHO guidelines for utilization review, discharge planning/quality assurance/infection control.
Knowledge of Milliman guidelines and Interqual criteria.
Understanding EPIC and the integration with INDICIA/CareWebQI.

Physical Demands:

Involves standing, walking, sitting, talking, hearing and bending.
May include some repetitive motions.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and can be modified in the future. When determining a team member’s base salary and/or rate, several factors may be considered as applicable (e.g., site, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The statements herein are intended to describe the general nature and level of work being performed by employees and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of One Brooklyn Health (OBH).

OBH is an equal opportunity employer, it is our policy to provide equal opportunity to all employees and applicants for employment without regard to race, color, religion, national origin, marital status, military status, age, gender, sexual orientation, disability or handicap or other characteristics protected by applicable federal, state, or local laws.

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Practices and ensures compliance with established infection control policies and procedures. May train paraprofessional staff by demonstrating nursing techniques and providing instructions on use of techniques and nursing equipment. Required Qualifications Open Competitive: possession of a license and current registration as a registered professional nurse in New York State. Preferred Qualifications Bachelor of Science Degree in Nursing. 1 year of relevant clinical experience. 55 B/C Qualifications Individuals certified eligible for the 55 B/C program under the Governor's Program to Hire Persons/Veterans with Disabilities pursuant to Section 55 B/C of the Civil Service Law will also be considered. To be considered, you must provide a copy of your letter of eligibility with your response. It is essential that candidates clearly and concisely indicate exactly how they meet the above minimum qualifications in their resume. Failure to show how you meet the minimum qualifications above may result in disqualification and removal from consideration. Work Schedule Variable Days; Variable Hours (Full-Time) Salary Grade/Rank SG-18 Salary Range As per civil service guidelines $69.00 per hour Executive Order Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation. If such information has been requested from you before such time, please contact the Governor’s Office of Employee Relations at (518) 474-6988 or via email at info@goer.ny.gov. Equal Employment Opportunity Statement SUNY Downstate Health Sciences University is an affirmative action, equal opportunity employer and does not discriminate on the basis of race, color, national origin, religion, creed, age, disability, sex, gender identity or expression, sexual orientation, familial status, pregnancy, predisposing genetic characteristics, military status, domestic violence victim status, criminal conviction, and all other protected classes under federal or state laws. Women, minorities, veterans, individuals with disabilities and members of underrepresented groups are encouraged to apply. If you are an individual with a disability and need a reasonable accommodation for any part of the application process, or in order to perform the essential functions of a position, please contact Human Resources at ada@downstate.edu