Accountable Care Manager

Position Overview This role coordinates and monitors the management of patient-centered quality care, ensuring optimal utilization of resources, service delivery, and compliance with external review requirements, applicable state and federal rules, and nursing standards, to improve patient outcomes and experience. Duties & Responsibilities Reviews each patient’s chart, ensuring documentation in the medical record supports the plan of care and justifies admission and continued stay. Coordinates or participates in multidisciplinary rounds, reviews the plan of care, discusses estimated length of stay, need for continued hospitalization, and appropriateness of resources, consultations, treatment and discharge plans, and completes the Patient Review Instrument (PRI). Collaborates and consults with physicians and other health care professionals to establish efficient pathways of care, identify and eliminate barriers, and collect and analyze related data as needed. Communicates with the investigation/reimbursement department and third-party payers to obtain authorizations, ensure appropriate reimbursement, and provide clinical reviews and updates to managed care companies. Plans and implements strategies to reduce length of stay, reduce resource consumption, and achieve positive client/patient outcomes; coordinates implementation of healthcare initiatives designed to increase revenue. Initiates discharge planning by assessing client/patient and family needs, including non-medical psychosocial needs and post-discharge medical needs, and informs patients and families of discharge planning options based on diagnosis, prognosis, resources, and preferences related to home care services. Coordinates and facilitates timely implementation of discharge plans for patients, ensuring completion of discharge, transfer, and referral forms, prescriptions, and discharge orders, and arranges follow-up care as appropriate. Performs or coordinates the post‑Emergency Department discharge phone call to patients and health care providers to facilitate/verify successful linkage to care. Maintains effective communication with physicians, nursing staff, clients/patients, families, and others related to discharge planning; coordinates with social services personnel to provide needed services. Contacts and directly engages the patient’s primary care physician and/or healthcare providers to support continuity of care and effective care transition. May interview, orient, train, mentor, and coach new care‑management staff, and coordinate and supervise the performance of care coordinators and social work staff conducting discharge planning and assessment. May collaborate in developing departmental policies and procedures, clinical practice guidelines, and critical pathways for designated targeted diagnoses. May act as an educational resource and provide consultation regarding case management, discharge planning process, clinical documentation requirements, and applicable federal, state, and local regulations; may identify benefits, implications, and limitations of home care. Minimum Qualifications Valid New York State license and current registration to practice as a Registered Professional Nurse issued by the New York State Education Department (NYSED). Baccalaureate degree in Nursing or related health field from an accredited college or university. Valid and current certification in Basic Life Support (BLS) through the American Heart Association (AHA). Two (2) years of experience as a Registered Professional Nurse. Department Preferences Participates in case‑management departmental trainings, meetings, presentations, and quality improvement initiatives and incorporates them into daily practice. Communicates professionally with colleagues and interdisciplinary team. Keeps informed of changes in regulations, procedures, and treatment standards prescribed by the health care setting, regulatory and/or reimbursement agencies. #J-18808-Ljbffr NYC Health + Hospitals