Accountable Care Manager

NYC Health + Hospitals; New York (NY); On-site; USD 70,000 - 100,000; Full time

Job summary

NYC Health + Hospitals is looking for a skilled Registered Professional Nurse to coordinate and manage patient-centered quality care in New York City. The ideal candidate will have a Baccalaureate degree in Nursing, a valid NY license, and at least two years of nursing experience. Responsibilities include collaborating with healthcare providers, managing discharge plans, and ensuring compliance with regulations. This role emphasizes effective communication and a proactive approach to patient care, aiming to improve outcomes and enhance patient experience.

Qualifications

• Valid New York State license and current registration as a Registered Professional Nurse.
• Certification in Basic Life Support (BLS) by the American Heart Association (AHA).
• Two years of experience as a Registered Professional Nurse.

Responsibilities

• Coordinate and monitor management of patient-centered quality care.
• Review patient charts and ensure documentation supports care plans.
• Collaborate with healthcare professionals to streamline care pathways.
• Communicate with payers for authorizations and reimbursements.
• Implement discharge plans and assess post-discharge needs.

Skills

Patient-centered care

Collaboration

Clinical documentation

Discharge planning

Communication

Education

Baccalaureate degree in Nursing or related health field

Job description

Duties & Responsibilities

Under general supervision, with varying degrees of latitude for independent initiative and judgment, coordinates and monitors the management of patient-centered quality care, ensuring optimal utilization of resources, service delivery, and compliance with external review requirements and applicable state and federal rules and regulations and nursing standards of care for better outcomes and improved patient experience. Facilitates patient's progress from admission through discharge, and promotes strategies and forums for collaboration and mutual problem solving.

Examples Of Typical Tasks

• Reviews each patient's chart. Ensures that documentation in the medical record supports plan of care and justifies admission and continued stay.
• Coordinates and/or participates in multidisciplinary rounds; reviews plan of care; and discusses estimated length of stay, need for continued hospitalization and appropriateness of resources utilization, consultations, treatment plan and discharge plan. Completes Patient Review Instrument (PRI).
• Collaborates and consults with physicians and other health care professionals to reach an efficient pathway of care taking and to identify, eliminate, and implement solutions to barriers, and collects and analyzes related data, as needed.
• Communicates with health care setting investigation/reimbursement department and third-party payers to obtain authorizations and ensure appropriate reimbursement, and provides clinical reviews and updates to managed care companies, as needed.
• Plans and implements strategies to reduce length of stay, reduce resource consumption, and achieve positive client/patient outcomes. May coordinate the implementation of health care setting initiatives designed to increase revenue. Maintains all related records and documentation.
• Initiates discharge planning by assessing client/patient and family needs, including but not limited to identifying non-medical psychosocial needs and post discharge medical needs. Informs patient and family of discharge planning options based on diagnosis, prognoses, resources and preferences related to home care services.
• Coordinates and facilitates timely implementation of discharge plans for patient; assures timely completion of discharge, transfer and referral forms, prescriptions, and discharge orders; arranges follow-up care, as appropriate.
• Performs or coordinates the post Emergency Department discharge phone call to patient and health care providers to facilitate/coordinate and verify that successful linkage to care occurred.
• Maintains effective communication with physicians, nursing staff, clients/patients, families and others related to discharge planning; coordinates with social services personnel to provide needed services.
• Contacts and directly engages patient’s primary care physician and/or health care providers to support continuity of care and effective care transition.
• May interview, orient, train, mentor and coach new care management staff, and coordinate and supervise the performance of care coordinators and social work staff performing discharge planning and assessment.
• May collaborate in the development of departmental policies and procedures, clinical practice guidelines and critical pathways for designated targeted diagnosis.
• May act as an educational resource and provide consultation regarding case management, discharge planning process, clinical documentation requirements and applicable federal, state and local regulations; may identify benefits, implications, and limitations of home care.

Minimum Qualifications

• Valid New York State license and current registration to practice as a Registered Professional Nurse issued by the New York State Education Department (NYSED); and
• A Baccalaureate degree in Nursing or related health field from an accredited college or university; and
• Holds, or obtains through facility orientation, a valid and current certification in Basic Life Support (BLS) through the American Heart Association (AHA); and
• Two (2) years of experience as a Registered Professional Nurse.