This role involves reviewing all hospital admissions and continued stays, classifying patients according to regulations, and facilitating interdisciplinary care plans in collaboration with patients and families. The Case Management Team RN also acts as a liaison between the hospital, physician, and payer to secure maximum reimbursement and coordinates complex discharge planning.
Requirements summary
Candidates must be a graduate of a school of nursing with a minimum of 3-5 years of clinical nursing experience, preferably in acute care settings, with prior case management or utilization review experience strongly preferred. Requirements include strong critical thinking, proficiency in EMR systems, knowledge of reimbursement processes like Medicare/Medicaid, and an active, unencumbered RN license in NY State.
Range: $39.97 - $60.40 Care for our community, and your career. Reviews all admissions to the hospital and reviews continued stay. Classifies all patients according to mandated federal and state regulations. Works with all departments to ensure quality continued stay and discharge planning. Facilitates the development of an interdisciplinary plan of care in conjunction with patients and families. Accurate timely documentation in medical record including clear communication with clinical discharge planner, nurse and QMP Functions as a liaison between hospital, physician, patient and payer to obtain maximum reimbursement for patient care services. Assists in the maintenance of communication between providers involved in patient care. Maintains compliance responsibilities. Screening patients to identify those at higher risk of needing more extensive Case Management based on objective criteria. Advocacy for patients and families, facilitates referrals to state and local financial assistance programs. Coordination of patient care conferences as needed for complex discharge planning issues. Serves as an advocate for the patient and coordinates with the acute care team members, payers and community resources to leverage resources to meet patient’s clinical and discharge needs. Collaborates with providers and nursing staff to identify patients appropriate for discharge today/tomorrow. Collaborates with UM Nurse to expedite discharges when payer denies admission or continues stay.
Leads
Multi-disciplinary
Rounds: facilitates identification of barriers to clinical progression discharge and assigns accountability for follow-up actions identified during rounds. Identifies and documents avoidable days. Identifies and addresses quality of care, safety, under/over utilization of resources and discharge planning barriers. Refers cases to physician advisor and second level review. : *Patient does not meet criteria for ordered level of care, Identified quality of care concerns, Identified delays in care, and over/Under utilization of resource. Provides direction and appropriately delegates tasks to the Clinical
Discharge
Planner,
Unit
Nurse or
QMP to arrange for post-acute services: Home health care, durable medical equipment etc. and ensure plan is complete. Maintains current knowledge of health care economics, trends and reimbursement methodologies, and applies this knowledge to daily practice. Duties to be assigned at hire by Manager/Director.
Job
Requirement
Minimum
Education
Requirement: Graduate of a school of nursing.
Minimum
Experience
Requirement: Minimum 3-5 years of clinical nursing experience, preferably in acute care settings. Prior experience in case management, discharge planning or utilization review strongly preferred. Familiarity with federal and state regulations regarding patient care and hospital operations. Strong critical thinking, problem-solving, and decision-making abilities. Proficient in electronic medical records (EMR) systems and documentation standards, Knowledge of insurance and reimbursement processes, including Medicare and Medicaid. Ability to work collaboratively in a fast-paced and interdisciplinary environment. Critical care experience is strongly recommended. Must possess and demonstrate knowledge of the growth and development of varied age groups, neonatal to geriatric. Ability to correlate statistical information and outline necessary steps involved in problem solving. Aptitude for repetitive activities. Organizational ability. Demonstrated ability to handle confidential hospital information. Well developed critical thinking skills. Knowledge and understanding of medical terminology. Ability to communicate effectively with medical professionals of all disciplines. Clear verbal and written communication skills, excellent phone etiquette. Knowledge of QI process and facility wide process improvement projects including but not limited to overall patient safety. Ability to identify potential and actual patient occurrences that may be reportable incidents or those requiring further internal investigation.
Minimum
License
Requirement: Active and unencumbered Registered Nurse (RN) license in NY State. Certification in Case Management (e.g. CCM ACM) preferred.
Physical
Requirement/Working
Conditions: Little or no personal exposure to any actual or potential health or accident hazard. Intermittent sitting, standing, walking and lifting (10 pounds).External applicants, as well as position incumbents who become disabled, must be able to perform the essential functions, either unaided or with the assistance of a reasonable accommodation to be determined on a case-by-case basis. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Samaritan is an Affirmative Action/Equal Opportunity Employer. Women, Minorities, Disabled, and Veterans are encouraged to apply.
Work
Shift:
FLSA7DAY- 8
Hours
Day
Shift (United
States of
America)
Position
Hours: 80 Samaritan is an Affirmative Action/Equal Opportunity Employer. Women, Minorities, Disabled, and Veterans are encouraged to apply. Introduce yourself to our recruiters and we'll get in touch if there's a role that seems like a good match.
Please call our
Recruitment
Hotline at: 315-779-5236. Talk with our Human Resources Professionals about current opportunities within the Samaritan Health System. Exceptional care starts with exceptional people. At Samaritan, everyone’s job is critical to the successful care of our patients. Be a part of an organization whose employees, medical staff, volunteers and students choose to spend their time here because they are dedicated, enthusiastic, truly care about making a difference…and are surrounded by over 2,500 others who feel the same way. Become part of an organization whose ongoing strategic planning drives our organization forward and sets the tone for future growth and development. Samaritan is a fiscally sound and stable organization. Thanks to the hard work and dedication of our medical staff and employees combined with careful management, our bottom line is strong, which allows us to provide stable jobs, and offer ever-improving quality of care. Enjoy the natural beauty of Northern New York, minutes from Lake Ontario and the St. Lawrence River. A safe community, low cost of living and minimal commute times mean more time for enjoying life outside of work. Exceptional, dedicated people, rewarding opportunities, an excellent compensation and benefit program, and the ability to shape healthcare in our community are some of the reasons to join Samaritan. In 1881, we began caring for our neighbors as the House of the Good Samaritan in a home with five beds. Today, Samaritan Health is a comprehensive not-for-profit health system. And as we’ve grown to meet the changing needs of our region, we’ve held fast to our community roots. At Samaritan, we’ve invested in the best medical talent, facilities and equipment to offer a full continuum of care close to home. That means our patients can spend more time healing and less time traveling out of the area for the care they need. As the largest hospital and the largest private employer in the region, the health of our community is our priority – in fact, it’s our mission. That’s why Samaritan invests time and resources to support local non-profit organizations and events. It’s also why our people lend a hand to little league teams, churches and fundraisers—all to help Northern New York thrive.
