The RN Onsite Case Manager at Stony Brook assists with the development, organization, implementation, monitoring and evaluation of activities related to the outcome management of members' healthcare needs at an assigned member hospital. Functions as a clinical resource/educator with the hospital's multi-disciplinary healthcare team in order to maximize quality of patient care, and effectively manage length of stay and utilization of resources.
Essential Duties and Responsibilities:
Other Duties and Responsibilities:
- Performs onsite health assessments to identify areas of concern and need. Ensures that inpatient, outpatient, psychosocial and medical needs of Healthfirst's members are addressed and carried out via appropriate education and resources available at their site.
- Troubleshoots 'high utilzer' members to address barriers of care as well as discourage use of Emergency Room and acute inpatient stays. Encourages use of PCP and Out-Patient Clinics to maintain their health and improve wellness.
- Encourages members to see their PCP; when they have, reviews PCP's findings with them to ensure they understand treatments and goals in their plan of care.
- Communicates with hospital staff (including attending practitioners, utilization review, and social workers) to implement appropriate discharge planning for inpatient members and coordinates care accordingly.
- Interacts with hospital's Director of Managed Care in order to encourage providers to follow current treatment and disease guidelines. Educates hospital providers about Healthfirst's entitlements and benefits.
- Documents all interventions with members, providers, assigned hospital staff into Healthfirst's MIS system in accordance with established documentation standards to insure integrity of member services.
- Assists in identifying opportunities for and facilitating alternative care options based on member needs and assessments.
Assists in identifying opportunities for and facilitating alternative care options based on member needs and assessments.
Required: Associate’s degree or Nursing Diploma and 10+ years of related nursing/case management experience will also be considered.
Licenses, certificates, etc.
Required: State RN License.
Preferred: Certified Case Manager.
Work Related Skills and Experience:
Technical Skills :
- Basic Microsoft Word, Excel and PowerPoint skills are required. Intermediate Microsoft Outlook and CCMS EMR skills are also required.
A minimum of two years of clinical and case management experience is required. This must include knowledge of the concepts and philosophy of case management, utilization review regulations, and relevant medical standards of practice.
- Good interpersonal and assessment skills.
- Demonstrated ability to educate and coordinate resources on an ongoing basis.
- Managed care experience strongly preferred.
While performing the duties of this job, this employee will occasionally be reaching, bending, walking, standing, driving, and traveling. This employee will also be frequently pushing/pulling and lifting/carrying 1-10lbs and constantly sitting and balancing.
Work Environment :
This employee will constantly be in an indoor environment and occasionally be hot and cold.
Must be willing to work on–site at Stony Brook Hospital 5 days a week. Prior to assignment to a specific hospital, must be able to train for at least 4 weeks at our Corporate Headquarters in downtown Manhattan.
Healthfirst offers a comprehensive benefits package including, but not limited to:
Conditions of Employment: Employee must pass pre-employment screening which includes a background check and drug testing. Employee must present documentation to verify minimum of high school educational requirement.
- Basic Life and Accident Insurance
- Supplemental Life insurance
- Dependent Life Insurance
- Short-Term Disability
- Buy-Up Short Term Disability
- Long-Term Disability
- Flexible Reimbursement Accounts
- Healthfirst 401(k) Plan
- Employee Assistance Plan
- Commuter Savings Program
- Eligibility for Annual Bonuses
- Generous Paid Time Off program
- Paid Candidate Referral Program
Disclaimer: The statements herein are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, national origin, disability or veteran status .
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