Care Manager-Care Management-Per Diem-Day-Mount Sinai Queens

The care manager as an integral part of the primary care team is responsible for collaborating with the patient and health care provider in identification and provision of patient’s treatment needs, barriers to self-management, monitoring of patient outcomes and referral to appropriate referral community services. Primary objectives of the position are to enhance the quality of care received by patients, improve disease related outcomes, and reduce the unnecessary use of inpatient and outpatient medical services.

• Collaborates with primary care physicians, specialists, and Healthfirst to identify moderate to high risk patients who will benefit from participation in Care                   
• Develops a tracking system for patient care coordination and care management across the continuum between PCP, specialist and/or other providers, supporting referral, test completion and report receipt, and an integrated plan of care.  
• Develops/manages tracking and documentation systems for patients admitted to and discharged from the hospital, patients seen in the emergency room (ER), and patients transitioning from or to any other health care facility.         
• Develop a plan of care with the patient/family and the health care provider, taking in consideration patient’s medical needs, knowledge of the disease, available support and resources and barriers for self management.        
• Ensures the plan of care is consistent with the patient’s clinical course.
• Facilitating smooth transitions of care for patients discharged from the hospital, emergency department or extended care facilities to reduce likelihood of readmissions and related complications.            
• Help develop and maintain a care management registry for documentation of highest risk patients, care management interventions, and care plans.
• Coordination of care with other care managers (home health care, payer case managers, etc.) and with specialists to maximize care and promote patient safety.  
• Assuring that care is patient-centered and that the patient/family are informed about the plan of care and are involved in decision-making about that care.
• Utilizing behavioral strategies to assist patients in adopting healthy behaviors, improving self-care and managing chronic disease.           
• Assisting patients in problem-solving issues related to the health care system, financial and psychosocial barriers.      
• Develop and maintain effective working relationship with community-based organizations that provide services to Healthfirst patients.

• Education: Registered professional nurse licensed to practice in the state of New York
• Experience: 3 - 5 years acute care experience. Experience in Care Management duties and managed care reviews.
• License/Certification: Registered professional nurse licensed to practice in the state of New York. PRI Certification

Collective bargaining unit: SEIU Local 144-MSQ-NonRN