Rehabilitation Medicine Case Manager

SUNY Downstate

New York (NY)

On-site

USD 110,000 - 123,000

Full time

2 days ago

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Job summary

SUNY Downstate Health Sciences University in Brooklyn seeks a full-time Utilization Review & Quality Assurance Senior Coordinator / Rehabilitation Case Manager to lead case reviews and coordinate discharge planning within the Rehabilitation Medicine team.

The role requires a BSN or MD, NY licensure, 2+ years in case management, and strong communication and organizational skills; experience with care management platforms is preferred. On-site day shift with collaborative team Rounds.

Qualifications

Bachelor of Science Degree in Nursing (BSN) or Medical Doctor Degree (MD).
New York State Registered Nurse Licensure or Medical Doctor Licensure.
2+ years of experience in case management.
Computer proficiency in Microsoft Word, Excel, PowerPoint.
Strong interpersonal, communication, administrative, and organizational skills.
Or, a satisfactory equivalent combination of experience, education and training to the above.

Responsibilities

Review patient records for medical necessity for admission to IRF per MCGs.
Provide feedback per MCGs and collaborate with social workers, case managers and physicians.
Validate admission and continuing stay criteria with payers and physicians.
Complete clinical reviews and forward to MCOs; assess patient progression toward outcomes.
Develop and evaluate discharge plans with the multidisciplinary team.
Communicate with patients and care teams to address reimbursement and discharge options.

Skills

Interpersonal skills

Communication skills

Organizational skills

Administrative skills

Education

Bachelor of Science in Nursing (BSN)

Medical Doctor Degree (MD)

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Job description

Are you looking to take your career to new heights with a leader in healthcare?SUNY Downstate Health Sciences Universityis one of the nation's leading metropolitan medical centers. As the only academic medical center in Brooklyn, we serve a large population that is among the most diverse in the world. We are also highly-ranked by Castle Connolly Medical, a healthcare rating company for consumers, among the top 5 leading U.S. medical schools for training doctors.

Job Description

The Department of Orthopaedic Surgery & Rehabilitation Medicine at SUNY Downstate Health Sciences University is seeking a full-time TH Utilization Review & Quality Assurance Senior Coordinator / Rehabilitation Case Manager. The successful candidate will:

Report to the Rehabilitation Medicine Division Administrator.
Review patient records for chief complaints, signs and symptoms of disease to justify medical necessity for admission to acute inpatient rehabilitation facility (IRF) per Milliman Care Guidelines (MCGs).
Provide critical feedback per established MCGs. Collaborate with social workers, referring case managers, and physicians for alternative care sites when appropriate.
Validate admission and continuing stay criteria with third party payers as well as primary care and attending physicians.
Complete clinical reviews and forward to MCOs. Use clinical knowledge and knowledge of anticipated response to treatment to assess patient progression toward anticipated outcomes.
Assess patients and care support for continuing care needs to develop, implement and evaluate an effective discharge plan in collaboration with the multidisciplinary team. Use knowledge of usual length of stay to initiate a plan for discharge.
Determine medical necessity, appropriateness of admission, continuing stay and level of care using a combination of clinical information, clinical criteria, and third-party information. Intervene when determinations are not in alignment with clinical information, clinical criteria, IT systems or third-party information to resolve the situation.
Communicate and coordinate with patients/care teams to intervene when progression is stalled or diverted.
Collaborate and communicate with patients/care teams related to reimbursement issues and to create a discharge plan. Support the process of patient choice in establishing a discharge plan.
Actively contribute to and participate in all IRF AM huddles, Rehab Unite team meetings, rehab unit related length of stay meetings, discharge planning rounds, unit daily reports, clinical practice team and department meetings. PRN participate in med-surg unit interdisciplinary team rounds.
Complete IRF discharge calls, perform utilization reviews, and facilitate peer-to-peer reviews in care management module.
Complete PRls and forward to SAR/SNF after patient/care team selection. Assist in Joint Reconstruction surgery QAPI and optimization.
Work in dynamic work environment across multiple settings, while frequently communicating with team members as necessary and appropriate.
Be a team player and a role model for other staff members and students.
Model the organization's WE CARE values.
Demonstrate flexibility and perform other job related duties as business need demands, as the position is not limited to the above description.

Qualifications

Required Qualifications

Bachelor of Science Degree in Nursing (BSN) or Medical Doctor Degree (MD).
New York State Registered Nurse Licensure or Medical Doctor Licensure.
2+ years of experience in case management.
Computer proficiency in Microsoft Word, Excel, PowerPoint.
Strong interpersonal, communication, administrative, and organizational skills.
Or, a satisfactory equivalent combination of experience, education and training to the above.

Preferred Qualifications

Graduate Degree in a healthcare related discipline.
Case Management Certification.
Experience with Orthopaedic Surgery service line.
Competency/experience with Careport, Allscripts EHR.

SUNY Downstate Health Sciences University is an affirmative action, equal opportunity employer and does not discriminate on the basis of race, color, national origin, religion, creed, age, disability, sex, gender identity or expression, sexual orientation, familial status, pregnancy, predisposing genetic characteristics, military status, domestic violence victim status, criminal conviction, and all other protected classes under federal or state laws.

Women, minorities, veterans, individuals with disabilities and members of underrepresented groups are encouraged to apply.

If you are an individual with a disability and need a reasonable accommodation for any part of the application process, or in order to perform the essential functions of a position, please contact Human Resources atada@downstate.edu.

Job Info