CASE MANAGER - RN - FT

How you move is why we’re here. ® Now more than ever. Get back to what you need and love to do. The possibilities are endless… Now more than ever, our guiding principles help us search for exceptional talent who align with our culture and desire to maximize growth opportunities. Emp Status: Regular Full time Compensation Range: $140,016.47 - $157,666.47 What you will be doing Develops/Manages Processes & Systems - Assists with contracts; assists in the negotiation of physician managed care contracts, analytics, and financial modeling. Upholds Standards/Expectations of HSS Staff - Coordinates enrollment; coordinates physician enrollment in managed care plans. Upholds Standards/Expectations of HSS Staff - Ensures compliance; ensures compliance of managed care companies with negotiated contracts. Upholds Standards/Expectations of HSS Staff - Resolves payor issues; follows-up and resolves payment issues with Insurance Payors. Upholds Standards/Expectations of HSS Staff - Acts as liaison; acts as a liaison between physician offices and Insurance Payors. Upholds Standards/Expectations of HSS Staff - Assists with meetings; schedules, coordinates, and documents for all PHO related meetings. Maintains Documentation & Manages Information - Maintains tracking logs; creates and maintains tracking logs for Insurance Payor issues and accountability for closing out items. Upholds Standards/Expectations of HSS Staff - Oversees PHO line; oversees PHO phone line, answers and responds to inquiries, and assists with urgent physician office issues. Upholds Standards/Expectations of HSS Staff - Attendance; maintains satisfactory attendance record. Upholds Standards/Expectations of HSS Staff - Maintains punctuality; reports for duty punctually. Upholds Standards/Expectations of HSS Staff - Adjusts to change; adjusts to changing situations and work assignments. Years of Experience (Required): Two years experience in case management with discharge planning or equivalent in acute or home care clinical setting. Years of Experience (Preferred): Orthopedic nursing; knowledge of regulatory agency standards; strong problem solving skills; ability to manage multiple tasks and projects independently; ability to assess clinical and discharge needs of orthopedic surgical patients; knowledge of Milliman (MCG) criteria; PRI/screen certification. Physical Working Conditions: Sitting in a comfortable position with frequent opportunity to move about the department and traverse the hospital campus. Environmental Working Conditions: Comfortable indoor area. Hazards (OSHA): Category 3 tasks that involve no exposure to blood, body fluids, tissues, or other potentially infectious materials. Category 1 tasks are not a condition of employment. Education Required: Bachelor’s degree in nursing. Education Preferred: None specified. Certifications/License Required: New York State professional RN license and/or registration. Certifications/License Preferred: CCM preferred. Skills Required: None specified. Skills Preferred: Ability to assess clinical and discharge needs of orthopedic surgical patients; knowledge of Milliman (MCG) criteria; PRI/screen certification. Non-Discrimination Policy: Hospital for Special Surgery is committed to providing high quality care and skilled, compassionate, reliable service to our community in a safe and healing environment. Consistent with this commitment, Hospital for Special Surgery provides care, admits, and treats patients and provides all services without regard to age, race, color, creed, ethnicity, religion, national origin, culture, language, physical or mental disability, socioeconomic status, veteran or military status, marital status, sex, sexual orientation, gender identity or expression, or any other basis prohibited by federal, state, or local law or by accreditation standards. #J-18808-Ljbffr Dormont Manufacturing Co