Position Summary: We have an exciting opportunity to join our team as a Care Manager.
In this role, the successful candidate is responsible for providing leadership and management of clinical care coordination, utilization management, and discharge planning. Assists the Sr. Director with systems, processes, and outcomes of clinical care teams and programs designed to address clinical, psychosocial, and financial needs of patients and families. Scope of responsibility includes training, supervision and evaluation of team members, and participation in goal setting, program planning, workflow process monitoring, regulatory compliance, staff productivity, assessment of good customer service, quality of work, outcome evaluation, and continuous quality improvement. Represents NYU Langone Medical Center to internal and external customers including patients and families, physicians and ancillary medical personnel, service leadership, administration, other hospitals, health plans and other third-party payors
Uses excellent communication skills with customers, using effective customer service strategies, and responding to customer questions and problems.
Makes skilled assessments of patients anticipated needs at discharge. Participates regularly in rounds or other team meetings, and actively takes part in interdisciplinary clinical case discussions. Helps develop effective and safe discharge plans in collaboration with the patients medical / surgical team(s).
Communicates with patients and families about the case management process and about how this enhances the team plans for patients post-hospital care.
Acquaints customers with the functions of other members of the care management team who might also need to assess and assist patient/family.
Refers patients to other members of the care management team as appropriate (social worker, transportation or equipment coordinator, etc.).
Documents accurately and concisely in the patients medical record and/or in any other required computer or ancillary tracking system(s).
Understands the value of teamwork and interdependency of various hospital disciplines, and establishes and maintains appropriate relationships across professional disciplines. Takes care to respect professional boundaries.
Fosters an exceptional teamwork environment with nursing teams and interdisciplinary colleagues; coaches staff in building strong team dynamics.
Welcomes constructive ideas and problem-solving by direct reports. Meets regularly with Sr. Director, managers and care managers to share plans and ideas, and to insure that employees across the department receive consistently clear information, direction, and assistance.
Participates in development and implementation of appropriate patient/family education material pertinent to population served. Helps Care Management team members to establish effective collaborative relationships with representatives of third-party payors and external health care agencies in ways that contribute to these providers development of an enhanced image of our medical center.
Ensures compliance with JCAHO, Federal and State requirements and professional standards for case management, utilization management, discharge planning/continuum of care through policy and procedure development, implementation, and monitoring.
Demonstrates knowledge of and role models the organizations Core Values in performance of duties and communication with patients, families, staff and all disciplines.
Assists Sr. Director and managers in designing, implementing, and maintaining efficient systems and processes which promote departmental efficiency, productivity, and assure compliance with regulatory standards. Controls work operations by establishing and implementing objectives, practices, and methods. Assesses and regulates staff compliance with the Hospitals high standards for exemplary customer service and communication. Promptly investigates problems/complaints and resolves when possible.
Develops and implements systems for compliance with government programs and other regulatory agencies. Assists Sr. Director and managers with design and implementation of data collection processes, insuring adequate and accurate data. Makes suggestions for data collection which enhance the care coordination process. Acts as an administrative liaison with third party insurers as appropriate to facilitate resolution of medical necessity determinations and fiscal denials.
Monitors reports, unusual incidents, patterns, and processes within the Care Management Department, and recommends changes and improvements. Monitors, controls and evaluates the quality and quantity of the work products. Participates in departmental, interdisciplinary, hospital and Medical Board committees as appropriate. Coordinates discharge appeals or issuance of Hospital Notices in accordance with State and Federal Regulations and departmental guidelines.
DECISION MAKING - Demonstrates the ability to find information necessary to make solid clinical and business decisions. Engages in collaborative decision-making where appropriate. Communicates decisions to direct reports in ways that are clear and fair. Handles team disagreements with understanding, collaborative problem-solving, and when necessary, appropriate firmness. Develops effectiveness at communicating unpopular decisions in ways that help the team continue to function effectively together. Consistently makes thorough risk assessments considering functional and cross-functional impact. Evaluates and implements changes based on data related to productivity, quality, and outcomes for assigned projects and programs.
RESOURCE MANAGEMENT - Demonstrates stewardship of financial, material, and human resources. Assists the Sr. Director Care Management in managing resources to meet budgetary goals while responding effectively to necessary program changes and altered staffing levels. Schedules and utilizes staff with flexibility so that the workloads are equitably distributed and productivity goals are met. Prioritizes and uses time effectively. Assists Sr. Director Care Management and management team with introduction and implementation of cost containment and conservation measures.
MANAGEMENT OF HUMAN RESOURCES - Recruits, orients, coaches, develops, supervises, and evaluates direct reports. Develops and retains staff within the department. Helps all employees enhance and maximize skills. Encourages cooperation and teamwork, and facilitates constructive conflict resolution. Motivates staff members so that they commit to meeting the established objectives and goals of the Department and Medical Center. Documents outstanding or unsatisfactory work, plans effective rewards or remediation, and provides ongoing performance feedback through each performance year. Conducts timely performance appraisals of all direct reports.
COMMUNICATION - Demonstrates positive communication skills in establishing and fostering professional working relationships. Uses positive communication skills when offering assistance or making suggestions. Promotes a climate of open communication and information-sharing among departmental members. Handles difficult communication with success on a consistent basis. Presents clear and concise written information. Displays skills in speaking, teaching, listening, and clarifying. Regularly uses and is able to teach skills regarding use of various information technology systems, documentation tools, and databases required in the course of care coordination duties. Educates nursing, medical and ancillary staff about care management role, relevant clinical criteria and resources available for patients, as well as regulatory and managed care requirements. Informs staff of departmental, medical center, and third party payor policies and procedures. Assists the Sr. Director Care Management and management team in assuring that these policies are implemented.
INSTITUTIONAL AND/OR PROFESSIONAL STANDARDS - Supports the mission, philosophy, standards, goals and objectives of NYU Hospitals Center and Care Management program. Complies with regulatory agencies, and institutional operating systems. Adheres to all Hospital Policies and Procedures. Knows and adheres to Infection Control and Environment of Care Guidelines and Procedures as they are described in the annual staff education module. Rigorously protects patient/customer confidentiality. Complies with HIPAA regulations. Assists with regular updating of department Policies and Procedures and Practice Guidelines. Promotes own professional growth and development in care management standards of practice and management principles.
Adheres to current Hospital and Departmental Performance/Quality Improvement priorities.
Participates in development of quality indicators and analysis of such indicators per departmental quality & performance improvement plan. Participates in quality studies through data collection..
Contributes to the development of new strategies to address transitional planning needs of specific assigned patient populations, improved care coordination and care management delivery.
Makes recommendations and take actions to improve structures, systems and outcomes.
Identifies and implements strategies to support Hospital and Departmental missions and priorities.
Uses evidence-based practice to initiate change and to drive improvement strategies.
Minimum Qualifications: To qualify you must have a Licensure as a Professional Registered Nurse in NYS with current registration. BSN required, or graduate of an accredited RN program with BS in related health care field. 5 or more years Supervisory or Management experience in related setting and program function; 3-5 years clinical experience, 5 or more years in case management, utilization management required with some discharge planning experience preferred. Excellent interpersonal skills, effective communication, negotiation and conflict management skills; creative problem solving and clinical leadership; change management, organizational and time management skills. Working knowledge of the principles of management and budgeting of FTE resources. Demonstrated knowledge and understanding of laws, rules, regulations and reimbursement regarding managed care and commercial insurance and federal and state government programs such as Medicaid and Medicare. Demonstrated leadership and organizational abilities. Sound knowledge of case/care management and utilization/resource management principles and processes. Knowledge of Microsoft Office and demonstrated proficiency in managing software such as Eclipsys Sunrise Clinical Manager (ICIS), Canopy, and ECIN..
Required Licenses: Registered Nurse License-NYS
Preferred Qualifications: Master's of Science in Nursing or relevant health related field desirable. Certification in PRI, Case Management, American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) or Certified Professional Healthcare Quality (CPHQ) preferred. Membership in case management and/or related specialty professional organization desirable
Qualified candidates must be able to effectively communicate with all levels of the organization.
NYU Langone Health provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.
NYU Langone Health is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision. We require applications to be completed online. If you wish to view NYU Langone Health's EEO policies, please click here. Please click here to view the Federal 'EEO is the law' poster or visit https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm for more information. To view the Pay Transparency Notice, please click here.
NYU Langone Health, a world-class patient-centered integrated academic medical center, is one of the nation's premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals – Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, one of only fi...ve hospitals in the nation dedicated to orthopaedics and rheumatology; and Hassenfeld Children's Hospital, a comprehensive pediatric hospital supporting a full array of children's health services across the medical center – plus the NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The medical center's tri-fold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education and research. For more information, go to www.nyulangone.org.