Note: The job is a remote job and is open to candidates in USA. Montefiore Einstein Technology is looking for a Case Management Supervisor to support and coordinate their Care Management Program. This role is responsible for ensuring high quality care through collaboration with various stakeholders and managing the Care Management team to optimize patient outcomes.
Responsibilities
- Responsible for supporting and coordinating hospital-wide Care Management Program to ensure the delivery of high quality, cost effective care through collaborative relations with physicians, care managers, patients/family, insurance carriers and other member of the health care team
- Directs appropriate length of stay decisions based on knowledge of State, Federal and Third Party regulations to decrease LOS, perform transitions of care and initiate timely discharges
- In addition to the day-to-day responsibilities, the Supervisor, Care Management will work in conjunction with the Director of Care Management on a variety of critical tasks including the management of one or more focused clinical initiatives
- Supports and manages the procedures and goals of the case management department
- Maintains positive relationship with external vendors, and providers
- Oversee staff that process referrals, authorizations, billing, utilization review and capitation for hospital services
- Supervises Care Managers in the management of patients across the continuum of patient care, from the patient’s entry into the health care system, until the appropriate outcome is achieved
- Ensure that all Care Management team members are properly and adequately trained and that they have the skills and abilities to perform the required functions
- Develop and implement on-going training related to Care Management and ensure the appropriate tools are available for implementation of policies and procedures
- Collaborates with care management leadership and works closely with all appropriate internal departments to resolve complex issues related to care management and social management of patients
- Identify areas for improvement in existing operational policies and procedures, develop recommendations for departmental senior management; and follow through with the implementation
- Directs appropriate length of stay discharge decisions based on knowledge of State, Federal and Third Party regulations
- Monitors and audit’s documentation from care managers
- Assist with scheduling and daily oversight of care managers
- Monitor performance and provides feedback
- Monitors system to ensure that admission to the hospital is appropriate and patient achieves length of stay targets and is referred to the appropriate setting in a timely manner
- Develops quality improvement indicators which will evaluate patients who are high cost, high resource users, frequent readmissions to the hospital, determination of patient/family/provider satisfaction, decreased fragmentation of care, identification and resolution of system barriers
- Actively communicates the outcome of the review process with Patient Financial Services and other disciplines as needed
- Conduct facility wide education on a periodic basis related to LOS initiatives and mentoring
- Manages activities related to overturning adverse determinations
- Will provided floor coverage as needed during periods of staffing changes under direction of care management leadership
- Continuous collaboration and touch base with care management leadership
- Other functions as required to support departmental activities
Skills
- Graduate from an accredited School of Nursing or college
- BSN Required
- 2-3 years' experience in hospital utilization review and or managed care
- 5 years' experience in an acute care setting or equivalent experience
- Strong problem solving skills required
- Current New York state RN license required
- Knowledge of DOH, JCAHO and Peer Review Organization requirements
- Knowledge of PC based systems to assist in data analysis
- Ability to communicate (written and verbal) effectively with medical and administrative staff in a positive, assertive, and professional manner
- Self-motivated, self-directed, well organized with excellent interpersonal skills required
- Demonstrated competency knowledge and ability to effectively care for the adult geriatric patient population
- MSN or MPA Preferred
- 1-3 years of management experience preferred
- Case Management certification preferred
Company Overview
Montefiore Einstein Technology began a cultural transition from a provider of IT services and support to an integral component of Montefiore Medical Center/Systems and its affiliates located in the Bronx, Westchester, and Rockland Counties, with our focus on Customer Service and meeting Montefiore’s Health Systems Mission, Vision, and Values. It was founded in 1884, and is headquartered in Bronx, New York, USA, with a workforce of 501-1000 employees. Its website is https://montefioreeinstein.org/.
