Overview Coordinates and ensures delivery of care; collects utilization management and quality assessment data; regularly interacts with physicians to clarify plans of care; and reviews patients for high-risk criteria for discharge planning needs. Responsibilities
- Monitors patients and determines needs for a timely discharge.
- Confers with 3rd party payers within 24 hours past notification.
- Conducts initial case review no later than 72 hours after admission.
- Screens patient to determine if he/she meets high-risk criteria for discharge planning needs.
- Develops discharge plan for uncomplicated cases.
- Makes referral to Social Worker for assessment and discharge planning as indicated.
- Collaborates with other members of the health care team to facilitate the progress of care.
- Ensures that a plan of care is developed expeditiously by the attending physician.
- Ensures that a plan of care is time oriented and has clearly defined objectives.
- Negotiates, if needed, with physician and other health care practitioners to develop a more effective care plan.
- Monitors duplication of tests, delays in diagnostic, treatment and/or scheduling.
- Ensures documentation of patient progress toward identified clinical outcomes by health care practitioners.
- Conducts concurrent review.
- Participates in the collection of data related to performance improvement.
- Reviews cases for continued stay appropriateness.
- Collaborates with physician regarding issues. If unsuccessful, refers to physician advisor.
- Accurately a document review findings and provides clinical information to 3rd party payers.
- Performs retro reviews as requested by 3rd party payers.
- Maintains current knowledge of developments in the field.
- Review professional literature to seek out and recommends improvements.
- Maintains competency by participating in in-service and continuing educational programs.
- Maintains membership in professional organizations, attends lectures, reads journals and articles.
- Develops and maintains a high level of patient and staff satisfaction.
- Displays courtesy, tact, and diplomacy when dealing with staff, colleagues, superiors, patients, hospital visitors, and vendors, representatives of other institutions, and government and regulatory agencies.
- Offers to assist those mentioned above in attaining their goals or completing their tasks whenever possible, or if unable, obtain appropriate assistance.
- Performs other related duties assigned by manager/supervisor. In an emergency, performs other duties necessary for the welfare of patients or the efficient operations of the institution.
Qualifications Education / Experience:Internal & 1199 SEIU:
- Graduate of accredited nursing program(s).
- Bachelor's Degree in Nursing preferred.
- Minimum three (3) years' experience in direct patient care.
Non 1199 SEIU Candidates:
- Bachelor's Degree in Nursing (BSN) required.
- Master's Degree in Nursing, preferred.
- Minimum three (3) years' experience in direct patient care.
- Will Accept Associate's Degree with minimum five (5) years' experience in direct patient care.
New Graduates:
- Bachelor's Degree in Nursing (BSN) required.
- All required certifications within six (6) months of hire.
Licenses, Certifications:
- Current NY State RN License required.
- Basic Life Support (BLS) required.
- Advanced Cardiovascular Life Support (ACLS) required.
- Pediatric Advanced Life Support (PALS) preferred.
- Case Manager Certification (CCM) preferred.
Knowledge and Skills:
- Critical thinking, math, and computer skills.
- Works as a team player.
- Demonstrates respect and professionalism in all interactions.
- Excellent oral and communication skills.
- Decision making and problem solving.
- Able to read, write, see and hear English.
- Ability to fully utilize BHMC's electronic record systems, equipment and other healthcare and billing systems relevant to this position.
Physical Requirements:
- Physically demanding, high-stress environment requiring prolonged periods of standing, reaching, walking throughout the working day.
- Position will be required to stoop, bend, lift, and carry items weighing up to 35 pounds for routine performance of essential functions.
- An individual in this position may be exposed to: Adverse indoor environmental conditions, Blood borne pathogens, Blood and body fluids, Physical hazards (e.g., needle pricks, etc.), communicable diseases, chemical hazards, radiation, and repetitive motions.
- Full range of body motion, able to lift up to 100 pounds, if necessary, to assist lifting and moving patients.
- Manual and finger dexterity, as well as hand and eye coordination.
- Corrected vision and hearing to within normal range.
- Frequently sitting at desk working on computer.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The statements herein are intended to describe the general nature and level of work being performed by employees, and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of The Brookdale Hospital Medical Center. BHMC is an equal opportunity employer, it is our policy to provide equal opportunity to all employees and applicants for employment without regard to race, color, religion, national origin, marital status, military status, age, gender, sexual orientation, disability or handicap or other characteristics protected by applicable federal, state, or local laws.