Êse Management, Education Services Manager-MSH-Case Management-Full Time-Days

Êse Management, Education Services Manager –Case Management-MSH- Full Time Job Req 2820828 Strength Through Diversity Ground breaking science. Advancing medicine. Healing made personal. Roles & Responsibilities: The System CM Manager, Education Services will develop and implement a standardized educational approach for case management staff and providers ensuring patient satisfaction is increased, appropriate reimbursement is received, and positive health outcomes are attained. This position will help to foster a case management culture that promotes best patient outcomes come from avoiding underuse or overuse of medical resources. A large focus will be on educating key stakeholders on care guidelines that are in strict accordance with the principles of evidence-based medicine. The incumbent will fully understand utilization review and case management trends, best practices, policies and guidelines and maintain proven leadership abilities and professional accountability through effective communication/relationship-building. The incumbent will maintain an extensive knowledge of the local and national healthcare environment, payer contracts/reimbursement. Employing performance indicators, variance reports, and other metrics to maintain a high degree of accountability this position will be responsible for noting variances in care transitions, readmissions and denials management with the implementation of strategies to address knowledge /learning deficits among case management staff. Key Responsibilities for System Case Management Education Services Manager Maintain current knowledge of case management and utilization review trends including the entire continuum of care within and beyond hospital walls Design and continuously improve/adapt curriculum depending on educational needs Develop lesson plans incorporating evidence-based research into educational plans, patient discharge and care transition plans including nursing practices Teach courses and provide training to case management nursing staff,adminsitrative staff, providers and physician advisors Serve as a mentor to nurses, and identify growth opportunities and educational needs for practicing case managers Promote critical thinking among case management nurses, and show commitment to professional development Develop and implement a new hire case management nursing orientation Review/update all case management competency documents III Educational Methodology Educational needs assessment Case studies Monthly educational seminars and quarterly updates Root cause Collaborative training IV Priority Focus Areas Human Resources Management Work closely with CM leadership and Human Resources to ensure efficient onboarding of new staff. Evaluation of staff skill set and competencies Develop a case management nursing orientation Implement a new hire feedback process Collaborate with CM leadership to develop an annual education plan Establish case management competencies and developmental goals Recruitment, orientation and retention strategies. Information Technology and Management Maintain a clear understanding of the impact of information technology (IT) on case management practice. Use technology in clinical and systems leadership settings. Collaborate to prioritize the best use of IT resources. Participate in identifying new technology and provide leadership for the implementation of new IT . MCG Evidence Based Training Ongoing education for case management nursing and physician advisors. Focus on MCG evidence-based care guidelines to help nurse case managers and providers drive informed care especially with conversations to external payers (insurance companies) Promote education initiatives that enhance utilization review, denials management and transitional care planning skills and competencies. Maintain data analysis providing insight into critical benchmarks such as length of stay, re-admissions, and skilled nursing facility/inpatient rehabilitation admission rates. VII Continuum of Care Educational Guidelines Ensure that evidence-based best practices and care-planning tools are standardized and consistently used throughout the system supporting clinical decision-making and documentation as well as enabling efficient transitions between care settings and reimbursement for services provided. Inpatient & Surgical Care Covers most hospital admissions with hundreds of condition-specific guidelines (including specific content for pediatric patients) Multiple Condition Management Covers common complex conditions most frequently seen in the acute setting Ambulatory Care ( Short Term Stays) Supports outpatient authorization of genetic medicine, procedures and diagnostic tests, injectable and high-cost medications, imaging, rehabilitation evaluations, therapies, and services, subspecialty referrals, and DME (durable medical equipment) VII Continuum of Care Educational Guidelines Home Care- Focuses on skilled care needs, including private duty nursing, in the home Behavioral Health Care-Provides optimal care criteria for mental health and treatment of substance-related disorders (including opioid management) across all levels of care General Recovery Care-Covers problem-oriented and complex patient situations not addressed by Inpatient & Surgical Care Recovery Facility Care-Focuses on optimal care within Inpatient Rehabilitation and Skilled Nursing Facilities Chronic Care-Supports chronic condition case management with assessments, patient-facing care plans, and patient handouts Transitions of Care-Assessments, care plans, and patient handouts that provide care-coordination guidance to help you move patients toward health Medicare Compliance- Easy access to Medicare’s National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) to empower clinicians with timesaving has and better documentation practices. VIII Implementation of a Case Management University (CMU) with Key Operating Modules Case Management Scope of Services & Standards of Practice The purpose of this module is to clarify and create common understanding of the scope of service of case management. The case management scope of service represents the functions and responsibilities associated with the case management practice. Case Management in health care delivery systems is a process that occurs across multiple settings and represents a wide range of services delivered to patients and their support systems. Case management standards of practice describe a competent level of care in each phase of the case management process. Case managers must integrate collaboration, accountability, professionalism, resource management, technology, certification, and advocacy into their standards. Reimbursement Trends and Practice Settings The purpose of this module is to improve reimbursement and ensure the consumer receives high-quality care. Educate on healthcare reimbursement updates and changes. Emphasize trends emerging as the Centers for Medicare and Medicaid Services focus more on high quality, lower cost care. CMS Programs and Conditions of Participation With a significant percentage of the population covered by Medicare programs, it is imperative that case managers understand the program, its requirements of providers, and its requirements for individual eligibility and coverage. Medicare Overview Understand how Medicare it is structured and its requirements for reporting and reimbursement. Case managers, as financial stewards to their organizations and liaisons to the interdisciplinary care teams and patients, must understand the Medicare program so that they can appropriately serve their patient populations and assure appropriate reimbursement of services. Medicare Patient Notifications Awareness of the Medicare Conditions of Participation requirements for patient notification and familiarity with the tools and forms needed for compliance. Understand the triggers requiring an Advance Beneficiary Notice of Non-coverage as well as the Hospital Issued Notice of Non-coverage and Medicare Outpatient Observation Notice. Familiarity with the form and delivery of the Important Message from Medicare outlining a patient’s right to appeal a discharge. Implement structure to ensure the Conditions of Participation requirements are met. Two Midnight Rule Hospitals can provide care to patients on either an inpatient or an outpatient basis. Reimbursements from Medicare are paid separately based on patient status and represent different payment amounts for patients receiving similar services, along with differing cost-sharing obligations. Shifting of services between inpatient and outpatient has significant implications for Medicare and reimbursement. Communication Communication involves a variety of methods used to interact with payers, providers and staff. Case managers will learn effective communication regardless of the medium. Case managers will learn societal or cultural influences regarding interpersonal communication and how to adhere to rules of etiquette established for successful communication. Obstacles to effective communication will also be identified and strategies to overcome them. Tools for Professional Communication Learn tools and best practices for enhancing communication. This module will review broad communication techniques, formulaic approaches such as the SBAR method. In addition to patient communication, interprofessional collaboration is paramount in improving patient care and care transitions. Professional Tools for the Case Manager Accountability and responsibility should be ingrained in every decision a case manager makes. Case managers will learn how to manage the consequences of their decisions as those decisions impact the patients, the care team, and the entire organization. Requirements: Bachelor of Science in Nursing (BSN) or Master of Science in Nursing (MSN) required. Must possess current valid license as a registered nurse in the state of practice Nurse educator certification preferred Experience Requirements 2-5 years’ experience working as a registered nurse in a clinical setting Previous experience in a teaching setting preferred Must possess valid basic life support (BLS) certification Strong oral and written communication skills Exceptional interpersonal skill Strength Through Diversity The Mount Sinai Health System believes that diversity and inclusion is a driver for excellence. We share a common devotion to delivering exceptional patient care. Yet we’re as diverse as the city we call home- culturally, ethically, in outlook and lifestyle. When you join us, you become a part of Mount Sinai’s unrivaled record of achievement, education and advancement as we revolutionize healthcare delivery together. We work hard to recruit and retain the best people, and to create a welcoming, nurturing work environment where you have the opportunity and support to develop professionally. We share the belief that all employees, regardless of job title or expertise, have an impact on quality patient care. Explore more about this opportunity and how you can help us write a new chapter in our story! Who We Are Over 38,000 employees strong, the mission of the Mount Sinai Health System is to provide compassionate patient care with seamless coordination and to advance medicine through unrivaled education, research, and outreach in the many diverse communities we serve. Formed in September 2013, The Mount Sinai Health System combines the excellence of the Icahn School of Medicine at Mount Sinai with seven premier hospitals, including Mount Sinai Beth Israel, Mount Sinai Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai West (formerly Mount Sinai Roosevelt), Mount Sinai Morningside ( Formerly St Luke’s), and New York Eye and Ear Infirmary of Mount Sinai. The Mount Sinai Health System is an equal opportunity employer. We comply with applicable Federal civil rights laws and does not discriminate, exclude, or treat people differently on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, or gender expression. EOE Minorities/Women/Disabled/Veterans Compensation The Mount Sinai Health System (MSHS) provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $127,044.00 - $190,565.00 Annually. Actual salaries depend on a variety of factors, including experience, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.