Catholic Health Services of Long Island
Receive alerts when this company posts new jobs.
Care Manager-PD - Util Rev/Care Mgmt/Qlty Assur
at Catholic Health Services of Long Island
Util Rev/Care Mgmt/Qlty Assur
- Participates in the development of department and continues updating the department's goals and objectives.
- Educates staff, physicians, patients and families in the case management process.
- Reviews new admissions and continued stay patients to determine whether InterQual criteria is met.
- Interfaces with representatives of third party payors to assist with the certification process and the discharge planning process. Responds to requests for reviews in a timely fashion to avoid denials.
- Reviews records and interacts with staff and physicians to obtain information about all aspects of patients. Transmits information to third party payors to avoid denials.
- Participates in rounds with members of other disciplines and identifies areas for improvement.
- Facilitates communication between patients, families and social workers.
- Interacts with social workers to affect safe discharge plans.
EXPERIENCE, EDUCATION AND TRAINING:
- Registered Nurse, NYS license
- BS in a health related field preferred
- In-hospital case management and discharge planning experience preferred
- Excellent written, verbal, statistical and interpersonal skills
- Certification in case management preferred
- PRI assessor