Care Manager-Care Management-Full Time-Day-Mount Sinai Queens

Responsible for coordinating the care of the patients across the continuum. Ensuring and facilitating the achievement of quality, clinical and cost outcomes; Negotiating, procuring and coordinating services and resources needed by the patient and family.

• Education: Registered professional nurse licensed to practice in the state of New York
• Experience: 3 - 5 years acute care experience. Experience in Care Management duties and managed care reviews.
• License/Certification: Registered professional nurse licensed to practice in the state of New York. PRI Certification

Collective bargaining unit: SEIU Local 144-MSQ-NonRN

 

• Review charts for appropriateness of admission/continued stays             
• Communicate with various departments when indicated to ensure tests that were ordered, are completed and followed up on            
• Follow up of abnormalities/delays: documentation, investigation, and treatment.                     
• Facilitate interdisciplinary rounds with house physician, social service, nursing and ancillary departments.       
• Refer cases to Risk Management when appropriate.         
• Concurrent and retrospective managed care reviews.       
• Identify patient’s stability for Alternate Level of Care; obtain proper signatures and complete form after communication with attending.     
• Enter appropriate ICD-9 codes and data entry codes for the Care Management worksheets       
• Complete any forms necessary in the discharge planning process including (but not limited to) PRI, M11Q, 485, and as requested by the Social Service Department.            
• When managed care denies payment for days during concurrent review, contact the attending with this information. The attending can either evaluate for discharge or we will give telephone number and case number to facilitate attending contacting medical director for concurrent appeal of the denial