Care Manager - Registered Nurse - Nights

Nursing -->
Care Management

Full-Time/Regular

NYU Langone Hospital—Suffolk is a 306-bed medical center, providing care to residents of eastern Long Island. The hospital facility is home to the Knapp Cardiac Care Center—an advanced heart disease diagnostic and treatment facility—as well as a modern ambulatory surgical pavilion with specialized services including women's imaging, a sleep laboratory, and bariatric surgery. Our Provisional Level 2 Trauma Center delivers comprehensive and specialized care for patients with traumatic injuries.

The Stroke Center at NYU Langone Hospital—Suffolk is designated by the New York State Department of Health as a Primary Stroke Center, with expert neurologists available to provide treatment 24 hours a day, 7 days a week. Additionally, NYU Langone Hospital—Suffolk has multiple outpatient sites, including an outpatient wound care center, a hemodialysis center, and various primary care and specialty offices.
For more information, go to NYU Langone Hospital—Suffolk , and interact with us on Linked In , Glassdoor , Indeed , Facebook , X , You Tube and Instagram .

We have an exciting opportunity to join our team as a Care Manager
- Registered Nurse
- Full Time Nights
- Care Management - - Monday
¿ Friday 8:00pm
¿ 8.
In this role, the successful candidate The RN Care Manager collaborates with the interdisciplinary team to implement the plan of care and transition strategies ensuring the achievement of desirable patient outcomes, appropriate length of stay, efficient utilization of resources, increased patient and family involvement, and patient/staff/family education. Implementation is accomplished through patient assessment, monitoring of the plan of care, review activities, coordination with the interdisciplinary team and any outside third-party payers, communicating with physicians, performing utilization management activities to avoid denials, reduce avoidable delays and control costs where possible, and by facilitating continuity of care across settings.

• Demonstrates accountability for utilization management functions and communication with payers to assure authorization and payment for hospital stay.
• Performs admission review within 24 hours of admission on all patients in case load utilizing Inter Qual Criteria to determine if patient meets medical necessity for admission.
• Initiates contact with attending physician to solicit additional information to support medical necessity for admission when there is not adequate information in the medical record.
• Suggests alternative level of care/treatment plan for patients not meeting medical necessity for admission.
• Refers cases for second level review that do not meet medical necessity or level of care requirements, according to department procedure.
• Documents review in Soft Med according to department procedure.
• Submits reviews to third party payors according to contract requirements in a timely manner.
• Assures days are approved and information is entered in Soft Med in a timely manner.
• Follows up with third party payors when there is a lack of response to request for authorization.
• Advocates for the patient, family, physician, and facility to obtain benefits from third party payors and others that provide financial assistance.
• Communicates with patients and families to ensure understanding of third-party payor guidelines.
• Conducts continued stay review as indicated based on clinical condition and third party payor requirements.
• Collaboratively institutes prevention plans to avoid third party payor denials and problems solves with the health care team when denials are received.
• Manages concurrent denial/appeal process in collaboration with…