Nurse Case Manager

100 Albany Med Health System; City of Albany (NY); On-site; USD 77,075 - 119,466; Full time

Job summary

Albany Med Health System is seeking a Case Manager in Care Management/Social Work to coordinate care across the hospital continuum and lead discharge planning from admission through post-discharge.

The role requires an NY RN license, at least 3 years of clinical experience, and preferred PRI and Case Management certifications. Strong communication and problem-solving skills are essential in a high-volume acute care setting.

Qualifications

• Registered nurse with NY license.
• Bachelor's degree preferred, not required.
• Minimum of three years clinical experience in an assigned service.
• Prior case management, utilization management and/or discharge planning/home care in a high-volume hospital preferred.
• PRI and Case Management certification preferred.
• Effective communication, facilitation, and organizational skills.
• Self-directed with adaptability in a changing environment.
• Basic knowledge of computer systems for utilization review.

Responsibilities

• Coordinate care across the continuum of care with interdisciplinary teams.
• Monitor clinical processes to ensure timely, appropriate interventions.
• Collaborate on discharge planning and resource coordination.
• Lead care conferences and educate patients and families.
• Review admission data and verify appropriate length of stay.
• Communicate with payers and ensure documentation compliance.
• Support quality improvement and utilization review efforts.

Skills

RN license NY

Strong communication

Organizational skills

Discharge planning

Utilization review

Education

Bachelor's degree

PRI Case Management certification

Tools

Computer systems

Job description

Department/Unit: Care Management/Social Work Work Shift: Day (United States of America) Salary Range: $77,075.00 - $119,466.00 The Case Manager is accountable to facilitate the interdisciplinary team to plan, coordinate, implement and evaluate patient care for assigned service line across the continuum of care. The Case Manager works proactively with the Quality Improvement Teams, patient care standards, Social Work, and utilization management to coordinate the appropriate use of resources to achieve maximum clinical and financial outcomes. The Case Manager participates in maintaining quality care and performance improvement through leadership, problem solving, decision making, and outcome measurement. The Case Manager functions as a resource for the health care team, community, patient/significant others/family and payers by functioning as a clinician, consultant, advocate and educator for assigned service.

Coordination of Care

• a. Assists the admission MD and or designated physician and the interdisciplinary teams in assuring coordination of care across the continuum of care in the hospital pre and post-op.
• b. Proactively monitor patients' clinical process through /patient care standards and evidence based guidelines to ensure timely, appropriate interventions that achieve optimal patient outcomes within appropriate LOS and financial constraints.
• c. Provides collaborative care management with the primary nurse in assessing for discharge planning needs, coordinating appropriate resources and evaluating effectiveness of the discharge plan. The discharge planning process needs to begin on admission.
• d. Collaborates with the health care team and appropriate department in the management of care across the continuum of care, including pre-admission, discharge, post-discharge, planning length of stay, and utilization of resources.
• e. Utilizes own special body of knowledge and evidence based guidelines to provide leadership and guidance to the health care team in formulating an individualized multidisciplinary plan of care to include: pre hospitalization, acute hospital care, discharge education, transition to home and use of community resources.
• f. Facilitates and participates in health care team care conference for patients with complex problems.
• g. Facilitates patient and family education and the discharge process to promote continuity of care and optimal patient outcomes.
• h. Demonstrates experience in the referral process and use of community resources.

Utilization Review

• a. Reviews data from admission screening to clarify admission diagnosis, establish appropriate length of stay, and identify any potential outliers and determine appropriateness of admission based on institutional standards and evidence based guidelines.
• b. Contacts payer source to confirm/negotiate benefits and provide concurrent reviews. Updated 1/2021
• c. Identifies capitated patients to determine appropriate utilization of series and coordinates post hospital care using defined standards.
• d. Identifies high-risk patients based on clinical and financial criteria for collaboration with patient financial services to problem-solve available resources.
• e. Ensures that appropriate medical/legal documentation is contained in patient's records.
• f. Complies with regulations established by third party payers including but not limited to notices of non-coverage reinstatement and continued stay.
• g. Follows department UM guidelines.

Quality Improvement

• a. Collaborates with the health care team in implementing strategies to reduce length of stay/resource consumption to optimize patient health status for an assigned service patient.
• b. Assesses educational needs and provides learning opportunities for health care professionals relevant to particular cases and selected patient care groups.
• c. Demonstrates creativity and critical thinking ability in the development of programs or projects.
• d. Works with quality improvement team for continuous improvement of patient care outcomes while increasing quality and decreasing cost.
• e. Ensure that communication and transmission ofdocumentation occurs with community agencies.

Measurement

• a. Collaborates with case management leadership to compile and report aggregate variances and data for specific patient care services
• b. Communicates and analyzes aggregate variances with members of the health care team and develops strategies for variance reduction.

Qualifications

• 1. Registered nurse with a current license in NY State.
• 2. Bachelor's degree preferred not required
• 3. Minimum of three years clinical experience in an assigned service. Acute care nursing and case management experience preferred.
• 4. Recent experience in case management, utilization management and/or discharge planning/home care in a high volume, acute care hospital preferred. PRI and Case Management certification preferred.
• 5. Demonstrates effective communication, facilitation, and organizational skills.
• 6. Assertive and creative in problem solving, critical thinking skills, systems planning and patient care management.
• 7. Self-directed with the ability to adapt in a changing environment.
• 8. Basic knowledge of computer systems with skills applicable to utilization review process.

Thank you for your interest in Albany Med Health System! 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.

Albany Medical Center is the centerpiece of medicine, research, and medical education in New York’s Capital Region and is the area's largest private employer with more than 10,000 employees. Albany Medical Center offers excellent career opportunities in a wide range of roles in both patient care and administration. We value all our staff members and offer outstanding employee benefits including:

• Excellent health care coverage with no copay at Albany Medical Center providers
• A wide array of services and programs to support emotional, physical, and mental wellbeing

Anchored in the state’s historic capital city, Albany Medical Center offers a full range of inpatient and outpatient care and is home to the region’s largest hospital, only Level 1 adult and pediatric trauma centers, and only children's hospital.

The downtown campus also offers opportunities at Albany Medical College.

Albany Medical Center, along with Columbia Memorial Health, Glens Falls Hospital, Saratoga Hospital, and the Visiting Nurses, form the Albany Med Health System, serving more than three million people over 25 counties.