Title: Case Manager-Appeals
Location: Long Island Jewish Medical Center -- New Hyde Park
Job Number: LIJ00063B
Our RN Case Manager, plays an essential role in the patient experience by developing and performing an age-specific plan of care for patients from their admission to the hospital, and throughout their hospital stay. In this role, you will facilitate the patient care experience, and develop and document a post discharge plan of care. You will contact insurance companies as needed, and provide information to managed care agencies when additional services are required.
- Assesses the needs of all patient admissions, and checks the status of each patient from admission to discharge
- Serves as facilitator and member of health care team
- Identifies all barriers encountered delaying patient discharge, e.g., testing, lab and x-ray results and facilitates same in order to expedite patient discharge
- Communicates with patients, physicians, nurses and social workers to identify patients who may require post discharge services. Attends rounds on patient units to screen patients for ongoing care and services needed after discharge
- Develops and documents a post discharge care plan in conjunction with other members of the health care team based on initial patient assessment
- Identifies an appropriate agency for providing comprehensive patient care based on patient needs and available resources
- Coordinates patient discharge with physician, managed care agency, social work services, patient and family
- Collects data referencing patient's progress and follows up on changes in patient's plan of care
- Contacts insurance company to assess coverage and the need for prior authorization for post-discharge care and advises patients of same
- Provides information to managed care agencies to enable them to provide required services to patients discharged in their care
- Identifies patient/family educational needs and arranges for those needs to be met prior to discharge
- Keeps abreast of developments in the field and serves as a resource to other staff
- Knowledge of patient care management, theories, and practices as normally acquired through the completion of a Bachelor's Degree in Nursing or related field.
- Current license to practice as a Registered Professional Nurse in New York State.
- PRI certification, preferred.
- Minimum of one (1) year utilization review/discharge planning and case management or related work experience to ensure familiarity with managed care services and federal/state regulations and trends in patient care.
- Strong organizational, communication and independent decision making skills required.
Transforming care, optimizing patient satisfaction and creating better patient outcomes are just some of the things our talented team members are doing at North Shore-LIJ each and every day. As a culture committed to providing our customers with the highest quality service, we stand behind our core values: Patients first; Caring; Excellence; Innovation; Integrity and Teamwork. It is our commitment and our culture that sets us apart from others and is the cornerstone of everything we do. Join an organization whose team members are valued, cared for and offered continuous opportunities to grow. Click on the link to learn more about us: www.northshorelij.com/goals
Job: Case Management