Manager of Utilization Review and Case Management Professional Development

Nursing --> Care Management Patchogue, NY • ID: 1162703_RR00121106 • Full-Time/Regular 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. Our Provisional Level 2 Trauma Center delivers comprehensive and specialized care for patients with traumatic injuries. The Stroke Center at NYU Langone Hospital—Suffolk is designated by the New York State Department of Health as a Primary Stroke Center, with expert neurologists available to provide treatment 24 hours a day, 7 days a week. Additionally, NYU Langone Hospital—Suffolk has multiple outpatient sites, including an outpatient wound care center, a hemodialysis center, and various primary care and specialty offices. For more information, go to NYU Langone Hospital—Suffolk, and interact with us on LinkedIn, Glassdoor, Indeed, Facebook, Twitter, YouTube and Instagram. Position Summary: We have an exciting opportunity to join our team as a Manager of Utilization Review and Case Management Professional Development - Care Management - Full-. In this role, the successful candidate 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. The hospitals case management model outlines a collaborative practice to improve quality through coordination of care impacting length of stay, minimizing cost, and ensuring optimum outcomes. The manager assures compliance with CMS Conditions of Participation regarding Utilization Review including implementation and annual review of the Utilization Management Plan and assisting with the coordination of the Utilization Management Committee. The manager is also responsible for ensuring compliance with all regulatory agency provisions of care regarding appropriate patient placement, discharge planning and patient needs for care, treatment, and services after discharge or transfer are met. The Manager of Utilization Review and Case Management Professional Development is responsible for the development and maintenance of the departmental orientation program and providing initial and ongoing education for the department. In conjunction with the Case Management Director is responsible for the departmental educational calendar. Job 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; reports and identifies data that indicates potential areas for improvement of care and services provided within the system. 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…