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About the Role

The Case Manager facilitates the interdisciplinary team to plan, coordinate, implement, and evaluate patient care across the continuum of care. This role proactively works with Quality Improvement Teams, patient care standards, and utilization management to coordinate resource use for optimal clinical and financial outcomes. The Case Manager acts as a resource for the healthcare team, community, patient/family, and payers, functioning as a clinician, consultant, advocate, and educator.

Responsibilities

Assists the admission MD and/or designated physician and interdisciplinary teams in coordinating care across the continuum of care, including pre- and post-operative hospital stays.
Monitors patients' clinical process using patient care standards and evidence-based guidelines to ensure timely, appropriate interventions for optimal patient outcomes within appropriate length of stay and financial constraints.
Provides collaborative care management with the primary nurse in assessing discharge planning needs, coordinating resources, and evaluating discharge plan effectiveness, beginning discharge planning upon admission.
Collaborates with the healthcare team and appropriate departments in managing care across the continuum, including pre-admission, discharge, post-discharge, length of stay planning, and resource utilization.
Utilizes specialized knowledge and evidence-based guidelines to lead and guide the healthcare team in formulating individualized multidisciplinary care plans, including pre-hospitalization, acute care, discharge education, transition to home, and community resource utilization.
Facilitates and participates in healthcare team care conferences for patients with complex problems.
Facilitates patient and family education and the discharge process to promote continuity of care and optimal patient outcomes.
Demonstrates experience in the referral process and use of community resources.
Reviews admission screening data to clarify admission diagnosis, establish appropriate length of stay, identify potential outliers, and determine admission appropriateness based on institutional standards and evidence-based guidelines.
Contacts payer sources to confirm/negotiate benefits and provide concurrent reviews.
Identifies capitated patients to determine appropriate utilization of services and coordinates post-hospital care using defined standards.
Identifies high-risk patients based on clinical and financial criteria for collaboration with patient financial services to problem-solve available resources.
Ensures appropriate medical/legal documentation is included in patient records.
Complies with regulations established by third-party payers, including notices of non-coverage, reinstatement, and continued stay.
Collaborates with the healthcare team in implementing strategies to reduce length of stay/resource consumption to optimize patient health status for assigned service patients.
Assesses educational needs and provides learning opportunities for healthcare professionals relevant to specific cases and patient care groups.
Collaborates with case management leadership to compile and report aggregate variances and data for specific patient care services.
Communicates and analyzes aggregate variances with healthcare team members and develops strategies for variance reduction.

Requirements

3 years of clinical experience in an assigned service - required
RN - Registered Nurse - State Licensure and/or Compact State Licensure Upon Hire - required
Demonstrates effective communication, facilitation, and organizational skills.
Assertive and creative in problem solving, critical thinking skills, systems planning and patient care management.
Self-directed with the ability to adapt in a changing environment.
Basic knowledge of computer systems with skills applicable to utilization review process.

Skills

Case management
Utilization management
Discharge planning
Home care
Communication
Facilitation
Organization
Problem solving
Critical thinking
Systems planning
Patient care management
Computer systems
Utilization review

Location

Day (United States of America)

Work Type

Experience Level

3 years of clinical experience

Education Level

Bachelor's Degree - preferred but not required
RN - Registered Nurse
Certified Case Manager and PRI Upon Hire - preferred not required

Salary/Compensations

$94,957.00 - $147,183.00

About the Company

Albany Med Health System is an equal opportunity employer.
This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that: Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

Equal Opportunity

Albany Med Health System is an equal opportunity employer.