CASE MANAGER - RN - FT - Hospital for Special Surgery : Job Details

How you move is why we are here. Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximize the abundant opportunities for growth and success. If this describes you then let's talk! HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment.

Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.

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. Examples: executive, management, administrative and secretarial positions.

Environmental Working Conditions: Comfortable indoor area. Examples: executive, management and secretarial positions.

Hazards OSHA: Category 3 Tasks that involve no exposure to blood, body fluids, tissues, or other potentially infectious materials and Category 1 tasks are not a condition of employment.

Position & Unit Accountabilities:

• 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 resolving 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 inquires, and assist 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.

Education Required: Bachelors degree in nursing Bachelors Nursing Education Preferred: Certifications/Licensure Required: New York State professional RN license and/or registration Certifications/Licensure Preferred: CCM preferred Skills Required: 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.