Montefiore Medical Center
Tarrytown, NY, United States
Healthcare, Nursing, Case Management
The Care Transitions Clinical Coordinator [CTCC] is responsible for managing all transitional careand/or utilization management activities for patients defined in his/her caseload. S/he ensures a timely transition along the care continuum. She/he is an active member of the interdisciplinary team with responsibility for assessing, planning, implementing and evaluating the care management of a select group of patients as well as providing input, through the interdisciplinary team planning process, into the care management planning for all assigned patients.
The CTCC is a registered professional nurse who conducts concurrent and retrospective utilization review activities to maintain compliance with regulatory, accreditation and contractual requirements; prepares appeals in response to third party payer denials; completes PRIs for designated patient care units; and identifies and records variance data. The CTCC formulates care plans in collaboration with patients/caregivers, other members of the IDT and payers that are in accordance with patient need and within regulatory and benefit coverage parameters. S/he helps determine and coordinate comprehensive care plans maximizing access to health plan benefits and community resources appropriate for the health care needs of the individual patient. The CTCC performs post-discharge follow up phone calls in patient populations determined to be at high risk for readmission for the purpose of assessing for clinical and/or psychosocial issues that might lead to readmission and determining appropriate action to address these issues in accordance with established protocols.
S/he participates in educational activities related to the clinical specialty, transitional care planning and participates in clinical research studies. S/he participates in performance improvement activities; maintains professional practice standards and clinical expertise; and demonstrates strong leadership skills. The CTCC actualizes the vision, mission, values, and balanced scorecard performance measures for Montefiore.
The CTCC supports Montefiore's mission and strategy by participating in Montefiore initiatives in the area of disease management and population health management and by linking patients to services throughout the continuum of care.
The CTCC demonstrates core and unit specific competencies based on the patient population served.
EDUCATION, TRAINING & EXPERIENCE:
Education and Job Requirement Qualifications:
A. New York State License for a Registered Professional Nurse and current registration.
B. Bachelors degree in nursing. Master's degree in nursing or a health-related field preferred.
C. Case Management and/or Utilization Review Certification preferred.
D. PRI assessor number required (hospital based positions only)
E. 5 years recent acute care clinical experience or case management experience preferred.
F. Proficiency in use of computer, including data entry, word processing, and electronic messaging required. Experience in the use of Windows-based software applications and experience in the use of an electronic clinical information system preferred.
G. Expert clinical knowledge of disease processes to identify care needs.
H. Ability to implement evidenced based care.
I. Understanding of the health care delivery system and its sites of care, delivery models, and the roles of various providers and health care professionals.
J. Ability to manage patient complexity and multiple patients with diverse needs.
K. Experience in interpreting and applying benefit coverage rules and assessing coordination of benefits guidelines and managed care regulations required.
L. Knowledge of and experience in the use of medical necessity screening criteria preferred.
M. Ability to build effective partnering relationships with other members of the internal and external care teams.
N. Analytical skills necessary for problem solving and clinical decision-making.
O. Excellent communication skills.
P. Excellent teamwork skills.
Q. Proficient with customer service principles.
R. Must demonstrate flexibility, adaptability and independent judgment.
S. Must be assertive, mature and confident.
Department: Revenue Cycle Bargaining Unit: NYSNA Campus: TARRYTOWN Employment Status: Regular Full-Time Address: 555 South Broadway, TarrytownShift: Day Scheduled Hours: 8:30 AM-5 PM Req ID: 101341
Montefiore is an equal employment opportunity employer. Montefiore will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.
Montefiore Medical Center
Website : http://www.montefiore.org