Manager of Utilization Review and Case Management Professional Development

About the role

NYU Langone Hospital—Suffolk is a 306-bed medical center, providing care to residents of eastern Long Island. The hospital facility is home to the Knapp Cardiac Care Center—an advanced heart disease diagnostic and treatment facility—as well as a modern ambulatory surgical pavilion with specialized services including women's imaging, a sleep laboratory, and bariatric surgery.

The Manager of Utilization Review and Case Management Professional Development is responsible for coordinating the functions of utilization review, discharge planning, and resource management to ensure, based on patient assessment, that care is provided in the most appropriate setting utilizing medically indicated resources.

Responsibilities

• Promote the mission, vision, and values of the organization
• Facilitate team meetings that foster interdepartmental collaboration with the Case Managers and Social workers as deemed necessary
• Participates in multidisciplinary meetings and Utilization Review/Case Management meetings
• Provides input in such meetings regarding utilization management and discharge planning
• Responsible for evaluating and screening potential admissions to the facility
• Knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage
• Communicate daily with admissions personnel regarding admissions and discharges to various units
• Cooperate with insurance companies, based on information received
• Ensures that the UM System is maintained or surpassed by collecting quality indicators and variance data and reporting the data to the appropriate department
• Educates physicians and staff regarding appropriate level of care/utilization issues
• Develop and implement methods, policies and procedures to improve the departments efficiency and overall effectiveness
• Oversight and evaluation of the discharge planner/ utilization review nurses
• Perform and oversee needs analysis and planning
• Work with executive leadership to ensure targets are met for the annual operating plan/financial management
• Ensures confidentiality of all patient information encountered
• Document patient screening, Ensure that appropriate referrals are made and documented
• Prepares qualitative and quantitative reports related to UR activities
• Participates in related training and professional development to develop competencies in utilization review
• Assures completion of new employee training and competency
• Identifies and documents educational needs of individual department members
• Reviews and identifies deficiencies and takes corrective action, as required
• Actively involved in measuring case manager performance and communicates results and trends to supervisor
• Actively participates as an interdisciplinary team member of all UR related activities
• Provides feedback to supervisor on ongoing basis in regard to concerns, improvements, changes, etc
• Identifies areas needing improvement and utilizes the facility performance improvement process
• Actively participates in department processes as required
• Brings to the Directors attention significant issues related to the processes
• Assists with special administrative tasks and projects to facilitate improved patient care and Case Management program evaluation as required
• Exhibits willingness to master new skills and accepts change as necessary within the department
• Participates in Quality Improvement activities as needed to continually improve their departments performance
• Demonstrates working knowledge of the job by seeking guidance and direction as necessary for optimum performance of daily assigned duties
• Continually strives to make productive use of time through careful coordination of daily tasks, setting priorities, and reducing non-essential interruptions in order to complete the job during the allocated time
• Interacts and communicates with others in a way that promotes a positive and cooperative work environment
• Demonstrates initiative and enthusiasm in performing job duties on a daily basis
• Consistently maintains composure and professionalism during difficult situations
• Demonstrates understanding of concepts of excellence in customer service and conducts duties in positive, customer-friendly manner to all customers of department, particularly patients, visitors, physicians, and other employees
• Performs other duties as assigned by the Case Management Director in a timely manner

Qualifications

To qualify you must have a Computer skills, EPIC, CarePort, Indicia, MCG, Power Point, Excel, Word. Required Licenses: Registered Nurse License-NYS

Pay

The salary range for the role is $84,956.87 - $127,888.28 Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need.