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Nursing --> Care Management Mineola, NY ID: 1162069_RR00120781 Full-Time/Regular NYU Langone HospitalLong Island is a 591-bed university-affiliated medical center, which offers sophisticated diagnostic and therapeutic care in virtually every specialty and subspecialty of medicine and surgery. We are a major regional healthcare resource with a deep commitment to medical education and research, offering a full complement of inpatient and outpatient services. At NYU Langone Health, equity and inclusion are fundamental values. We strive to be a place where our exceptionally talented faculty, staff, and students of all identities can thrive. We embrace inclusion and individual skills, ideas, and knowledge. Position Summary: We have an exciting opportunity to join our team as a Care Manager (RN Hospital Care Management Experience Highly Preferred (Sunday-Thursday, 8:00AM-4:00PM). In this role, the successful candidate coordinates and procures services necessary to meet the post-acute care needs of patients identified as requiring such services. Ensures a timely and smooth transition to the most appropriate post-acute care setting. Works collaboratively with interdisciplinary patient care staff both internal and external to the organization. Participates in quality improvement and evaluation processes related to the management of patient care. Ensures maximization of provider reimbursement of patient days through timely and accurate insurance reviews. Job Responsibilities: • Performs other duties as assigned, • Performs an initial utilization review of patients for appropriateness of setting using industry standard utilization clinical criteria including, but not limited to InterQual, Milliman Care Guidelines (MCG), etc. Collaborates with the Attending of record and the Physician Advisor as indicated for review of any patient not meeting criteria for level of care ordered. Performs continued stay and extended stay reviews when there is a change to a higher level of acuity, authorized days expire, required by the insurance payer contractual agreement, stay is denied or reduced to a lower level of care., • Provides patient clinical reviews to payer in a timely and efficient manner to obtain certification of the patient days and secure reimbursement. Confers with Attending Physician, Physician Advisor, and multidisciplinary team as needed to mediate concurrent denials., • Screens all inpatients utilizing case management departmental screening criteria for potential post acute care needs. Perform an assessment for discharge needs for all patients that meet screening criteria, are referred by care team or are requested by patient/designee. Develops a discharge plan in collaboration with the patient/designee and care team incorporating patient preferences. Implement the discharge plan with referrals, including necessary medical information, to appropriate post acute care services. Reassessment of this process will be done with ongoing review of all readmissions to ensure that the plan was responsive to the discharge needs., • Completes all necessary documentation as per departmental policy and procedure utilizing Allscripts. Completes Patient Review Instrument (PRI) accurately and in a timely manner., • Identifies and reports risk and quality issues to appropriate department. Tracks avoidable days in Allscripts to identify opportunities for improvement., • Provides patients with all necessary notices in accordance with requirements for CMS conditions of participation and insurance payer contracts. Issue Important Message (IM), Discharge Notice, Advanced Beneficiary Notice (ABN), Detailed Notice of non-coverage, Preadmission/Admission Notice of non-coverage and Hospital Issuance of non-coverage (HINN) as appropriate and in accordance with hospital policy and procedure. Process Medicare Code 44 as appropriate in accordance with policy. Ensure patient designee is provided with explanation of billing status when a Code 44 or observation is ordered., • Participates in patient care unit interdisciplinary meetings to assess patients' current and projected clinical status, plan of care, discharge plan and expected discharge date. Facilitates communication among the interdisciplinary health care team members. Coordinates patient care conferences among appropriate team members and patient/designee to discuss identify barriers, concerns, resolve conflicts and communicate choices in the plan of care. Participates in in-service activities and continuing education programs as scheduled. Minimum Qualifications: To qualify you must have a Bachelor's degree in Nursing required for employees hired after 9/1/2020 (those who were hired prior to 9/1/2020 are grandfathered). Current and valid New York State Registered Nurse License. BLS certification (Issued by the American Heart Association-AHA). 3 - 5 years Clinical acute care. Excellent communication (both oral and written), interpersonal, organizational skills. Knowledge of clinical standards of practice for multiple patient populations. Computer skills. Required Licenses: Registered Nurse License-NYS Preferred Qualifications: Bachelor's Degree Nursing. New York State Department of Health Patient Review Instrument (PRI) Assessor. 3 - 5 years Discharge planning and/or utilization management. Knowledge of post-acute care referral process for the procurement of patient services. Knowledge of Hospital reimbursement process, insurance denials and appeals. Qualified candidates must be able to effectively communicate with all levels of the organization. NYU Langone HospitalLong Island provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents. At NYU Langone Health, we are committed to supporting our workforce and their loved ones with a comprehensive benefits and wellness package. Our offerings provide a robust support system for any stage of life, whether it's developing your career, starting a family, or saving for retirement. The support employees receive goes beyond a standard benefit offering, where employees have access to financial security benefits, a generous time-off program and employee resources groups for peer support. Additionally, all employees have access to our holistic employee wellness program, which focuses on seven key areas of well-being: physical, mental, nutritional, sleep, social, financial, and preventive care. The benefits and wellness package is designed to allow you to focus on what truly matters. Join us and experience the extensive resources and services designed to enhance your overall quality of life for you and your family. NYU Langone HospitalLong Island is an equal opportunity employer and committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration. We require applications to be completed online. View Know Your Rights: Workplace discrimination is illegal. NYU Langone Health provides a salary range to comply with the New York state Law on Salary Transparency in Job Advertisements. The salary range for the role is $147,153.96 - $180,190.08 Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

Nursing --> Management/Leadership Mineola, NY Full-Time/Regular NYU Langone HospitalLong Island is a 591-bed university-affiliated medical center, which offers sophisticated diagnostic and therapeutic care in virtually every specialty and subspecialty of medicine and surgery. We are a major regional healthcare resource with a deep commitment to medical education and research, offering a full complement of inpatient and outpatient services. At NYU Langone Health, equity and inclusion are fundamental values. We strive to be a place where our exceptionally talented faculty, staff, and students of all identities can thrive. We embrace inclusion and individual skills, ideas, and knowledge. We have an exciting opportunity to join our team as a Supervisor-Care Management. In this role, the successful candidate supervises the utilization management in accordance with the Hospital Utilization Review (UR) Plan, in addition to discharge planning and progression of care management in order to promote quality of care, safe transitions in care and appropriate utilization of resources. Responsible for the coordination and maintenance of programs/processes necessary for the daily operations of the Case Management Department. • Provides for in-service educational updates as necessary for staff development. Schedules educational services to other disciplines as necessary for the promotion of quality patient care., • Participates in the development of policies and procedures of the Case Management Department inclusive of the functions of utilization management, discharge planning, post-acute care placement, and insurance denial appeals., • Oversees the departmental quality performance improvement program. Supervises staff referral of recognized quality of care issues to the Quality Management Department for assessment. Oversees the departmental quality improvement program inclusive of the maintenance of quality indicators and their measurement., • Performs other duties as assigned, • Supervises departmental activities regarding utilization management and concurrent denials. Oversees completion of utilization management admission and continued stay screening and assessment procedures inclusive of the appropriate documentation according to departmental standards. Supervises the issuance of Hospital Issued Notice of Non-coverage (HINN)Notice Of Non-Coverage (NONC) Notice Of Discharge and Medicare Appeal Right (NODMAR) letters to patients as appropriate., • Oversees completion of discharge planning screening and patient assessment procedures inclusive of the appropriate medical record documentation according to departmental standards. Facilitates interdisciplinary health care team communication and coordinates case conferences as warranted. Supervises the implementation of comprehensive post-acute care discharge plans based upon in-depth assessment of patient needs inclusive of coordination of interdisciplinary and community activities. Facilitates collaborative relationships with external post-acute care agenciesfacilities., • Provides guidance and support to staff regarding progression of care management including partnering with Physician Advisors to Promote Overall Winthrop Efficiency (POWER) with unit rounds and service specific rounds. To qualify you must have a Bachelor's Degree Nursing. Current and valid New York State Registered Professional Nurse license. BLS certification (Issued by the American Heart Association-AHA). NYS DOH certification as a Patient Review Instrument (PRI) Assessor. 3 - 5 years in depth experience inclusive of acute care clinical patient care, utilization management, discharge planning, post acute care placement, and insurance denial management. Excellent communication (both oral and written), interpersonal, strong organizational, leadership, prioritization, problem solving and deductive reasoning skills. Knowledge of insurance denial and appeals process inclusive of external appeal, dispute resolution authority issues, commercial and government reimbursement mechanisms and managed care issues. Enhanced understanding of utilization management, progression of care, and case management operations within the acute care Hospital setting. Expanded clinical knowledge of standards of practice applicable to levels of patient care. Basic computer skills including MS Office. Master's Degree Nursing. NYS Department of Health (DOH) certification as a Screen Assessor. 1-2 years Management or supervisory. Qualified candidates must be able to effectively communicate with all levels of the organization. NYU Langone HospitalLong Island provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents. At NYU Langone Health, we are committed to supporting our workforce and their loved ones with a comprehensive benefits and wellness package. Our offerings provide a robust support system for any stage of life, whether it's developing your career, starting a family, or saving for retirement. The support employees receive goes beyond a standard benefit offering, where employees have access to financial security benefits, a generous time-off program and employee resources groups for peer support. Additionally, all employees have access to our holistic employee wellness program, which focuses on seven key areas of well-being: physical, mental, nutritional, sleep, social, financial, and preventive care. The benefits and wellness package is designed to allow you to focus on what truly matters. Join us and experience the extensive resources and services designed to enhance your overall quality of life for you and your family. NYU Langone HospitalLong Island is an equal opportunity employer and committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration. NYU Langone Health provides a salary range to comply with the New York state Law on Salary Transparency in Job Advertisements. The salary range for the role is $133,380.00 - $168,000.00 Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

Job Description MDS Coordinator RN The Glengariff Healthcare Center is looking for a talented and hard-working MDS Coordinator to join our ever-growing team. We are seeking qualified candidates who have experience as an RN within MDS field and are committed to help our patients and facilities receive the support they need. Responsible for completion of the Resident Assessment Instrument in accordance with federal and state regulations and company policy and procedures. Acts as in-house case manager by considering all aspects of the residents care and coordinating services with physicians, families, third party payers and facility staff. MDS Coordinator Essential Job Functions • Oversees accurate and thorough completion of the Minimum Data Set (MDS), Care Area Assessments (CAAs) and Care Plans, in accordance with current federal and state regulations and guidelines that govern the process, • Acts as an in-house Case Manager demonstrating detailed knowledge of residents health status, critical thinking skills to develop an appropriate care pathway and timely communication of needed information to the resident, family, other health care professionals and third party payers, • Proactively communicates with Administrator and Director of Nursing to identify regulatory risk, effectiveness of Facility/Community Systems that allow capture of resources provided on the MDS, clinical trends that impacts resident care, and any additional information that has an affect on the clinical and operational outcomes of the Facility/Community, • Utilizes critical thinking skills and collaborates with therapy staff to select the correct reason for assessment and Assessment Reference Date (ARD). Captures the RUG score which reflects the care and services provided, • Demonstrates an understanding of MDS requirements related to varied payers including Medicare, Managed Care and Medicaid, • Ensures timely electronic submission of all Minimum Data Sets to the state data base. Reviews state validation reports and ensures that appropriate follow-up action is taken, • Facilitates the Care Management Process engaging the resident, IDT and family in timely identification and resolution of barriers to discharge resulting in optimal resident outcomes and safe transition to the next care setting, • Directly educates or provides company resources to the IDT members to ensure they are knowledgeable of the RAI process. Provides an overview of the MDS Coordinator and Assessor role to new employees that are involved with the RAI process. Teach and train new or updated RAI or company processes to interdisciplinary team (IDT) members as needed, • Analyzes QI/QM data in conjunction with the Director of Nursing Services to identify trends on a monthly basis, • Responsible for timely and accurate completion of Utilization Review and Triple Check, • Serves on, participates in, and attends various other committees of the Facility/Community (e.g., Quality Assessment and Assurance) as required, and as directed by their supervisor and Administrator MDS Coordinator Qualifications: • Registered Nurse with current, active license in state of practice., • Minimum two (2) years of clinical experience in a long term care setting, • Minimum of one (1) year of experience in a long term care setting, • Prior experience as an MDS required; minium of 1 year Salary: Up to $110,000 a year (Based on experience) An Equal Opportunity Employer INDRN

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