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**Req Number** 168758

Job Summary

Serves as liaison between the patient and facility/physician. Ensures a continuum of quality

patient care throughout hospitalization and oversees provisions for patient's discharge.

Assesses, plans, oversees and evaluates the appropriateness of care throughout admission

and hospitalization of the patient.

Job Responsibilities

* * Facilitates patient management throughout hospitalization.

* Participates in patient management rounds and patient centered

meetings.

* Identifies potential delays and resolves issues with appropriate

departments.

* Identifies appropriate utilization of Social Work Services and makes

referrals when appropriate.

* Confers with physician regarding referrals for Physical Therapy, nutrition,

speech and swallow.

* * Serves as an in-patient liaison - planning, assessing, implementing and

evaluating patient in collaboration with the health care team.

* Serves as a resource to the health care team regarding quality, utilization

of clinical resources, payer, and reimbursement issues.

* Works with on-site screeners in transitioning patients to appropriate post

discharge settings.

* Collaborates with payers, providing all necessary clinical documentation

for the maximization of benefits.

* Serves as a liaison to patient, family, admitting, primary care physician,

health care team, and hospital departments.

* Collaborates with and provides feedback to the primary care physician

and multidisciplinary team regarding patient's status with regard to length

of stay, utilization of resources and discharge status.

* * Provides support to the in-patient health care team as well as to patient and

family regarding all aspects of admission, hospitalization and discharge plan.

* Involves patient and/or family in discussion and planning for anticipated

need for care following discharge.

* Ensures patient and/or family are given information regarding their

choices regarding transferring the patient to another level of care

according to regulatory standards.

* * Performs concurrent utilization management using Interqual criteria.

* Conducts chart review for appropriateness of admission and continued

length of stay.

* Contacts and interacts with third party payers to obtain approval of

hospital days, pre-certification and post-discharge eligibility in relation to

clinical course.

* Ensures compliance with current state, federal, and third party payer

regulations.

* Identifies patients for Alternate Level Care (ALC) care list and notifies

appropriate health team members.

* Communicates with insurance companies and physicians regarding

utilization issues.

* Utilizes important message from Medicare (IMM) when appropriate.

* Ensures managed care reviews are up to date and accurately reflect

patient's clinical progress and acute needs.

* * Participates in the quality management of patient care outcomes.

* Submits data to management regarding case management and/or quality

initiatives.

* Participates in data collection regarding patient's length of stay, utilization

of clinical resources, IPRO citations including appropriate

recommendations and re-admission within 30 days.

* * Initiates appropriate discharge planning as supported by initial assessment at

time of admission

* Reviews patient's chart.

* Assesses each patient physically, psychosocially and financially.

* Assesses patient's support system to facilitate appropriate discharge to

community.

* Substantiates, with the physician, the need for home care services.

* Coordinates procurement of any supplies, equipment or home lab work

needed by patient to evaluate discharge.

* Arranges for post-hospital transportation, when indicated.

* Interacts and coordinates with community agencies, families, vendors

facilities and institutions to facilitate patient discharge.

* * Documents the case management process in the medical record.

* Completes and documents a psychosocial assessment on the patient.

* Documents on-going processes of patients' hospitalization.

* Documents finalized discharge plan and disposition.

* Completes applicable areas of the Patients Discharge Instruction Sheet

and the Patient Transfer Sheet.

* Ensures Patient Review Instrument (PRI) is completed and reflects

clinical profile of the patient.

* Ensures case management sheet is current and accurate.

* * Performs related duties, as required.

*ADA Essential Functions

Additional site-specific qualifications may apply

Job Experience &Qualifications

* Bachelor's Degree in Nursing, required.

* Current license to practice as a Registered Professional Nurse in New York State.

* Case Management Certification, preferred.

* Minimum of one (1) year related experience, required. Experience in case

management and clinical pathways, variance analysis and trending, quality

management/utilization review and home care/discharge planning, preferred.

* Keeps abreast of developments in the field and serves as a resource to other staff.

The salary range for this position is $57.46-$76.07/hour

It is Northwell Health’s policy to provide equal employment opportunity and treat all applicants and employees equally regardless of their age, race, creed/religion, color, national origin, immigration status or citizenship status, sexual orientation, military or veteran status, sex/gender, gender identity, gender expression, disability, pregnancy, genetic information or genetic predisposition or carrier status, marital or familial status, partnership status, victim of domestic violence, sexual or other reproductive health decisions, or other characteristics protected by applicable law.