Kings County Hospital Center has a rich legacy for its pioneering role in medicine. Today, with over 625 beds, our hospital remains on the cutting edge of technology and provides the most modern procedures with state-of-the-art equipment. Built in 1831 as a one room infirmary for publicly supported care of the sick, Kings County Hospital Center continues to be a leading healthcare facility whose mission is to provide care to everyone regardless of their ability to pay. The hospital provides a wide range of health services, and specialties are offered in all fields of modern medicine. More than 200 clinics provide a wide array of ambulatory care services.

At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.

Work Shifts

9:00 A.M - 5:00 P.M

Job Description

PURPOSE OF POSITION

Under the direction of the Department Head, or designee- with varying degrees of latitude for independent initiative and judgment, participates in planning, organizing, directing, coordinating, implementing, and evaluating Utilization Review (UR), Care/Case Management (CM) services. This includes all activities related to Care/Case Management, Utilization Review, Discharge Planning, Transition of Care, Revenue Cycle, compliance with Policy & Procedures, and adherence to regulatory agencies etc. towards achieving the systems Vision & Mission, Quadruple AIM and organizational objectives.

AREAS OF RESPONSIBILITIES

Utilization Review/ Utilization Management

Discharge Planning

Transitions of Care

Care & Case Management

Denials & Appeals

Revenue Cycle

QIO Liaison

SUMMARY OF DUTIES AND RESPONSIBILITIES

Examples of Typical Tasks:
1. Performs all duties of the department head in his or her absence.
2. Participates in developing philosophy, objectives, policies and standards of service and education.
3. Assumes responsibility for developing and implementing a staffing plan and directing recruitment and selection of personnel.
4. Develops, plans, coordinates, directs and evaluates assigned projects and programs.
5. Assists in preparation of personnel, supply and equipment budgets.
6. Assumes responsibility for planning, directing, organizing and evaluating programs of orientation, training and continuing education for personnel.
7. Assumes responsibility for directing the evaluation of personnel performance.
8. Participates in developing and maintaining sound relationships with community, labor and professional groups in developing new programs and policies.
9. Assumes responsibility of day-to-day operations of service.
10. Assesses department services by making rounds, conducting chart review and evaluating patient care.
11. Participates in a system of continuing evaluation of service.

Consistent with corporate job description manages department operations and activities as follows:

• Management of department staff: assignment, performance, evaluations, trainings etc.
• Management of medical necessity for admission, continued stay, and discharge readiness
• Performs audits of clinical reviews and appeal letters for performance improvements
• Timeliness of clinical reviews to meet MCO and regulatory requirements
• Length of Stay (LOS) & Alternate Level of Care (ALOC) management
• Care coordination and discharge planning across the care continuum
• Readmission prevention initiatives e.g. Project RED, DSRIP
• Denials & Appeal activities
• Liaison between facility departments & providers, Physician Advisors, Network, Acute facilities, Post-Acute care providers, Community based services, Manage Care Organizations (MCO), Department of Health (DOH), Centers for Medicare and Medicaid (CMS), JCAHO, IPRO, Lavanta, QIO's, and other regulatory agencies and the like
• Serve on committees and actively participates in meetings
• Consultant regarding UR/CM issues or policies
• Development, implementation, and updating Policy and Procedures, and standard work
• Quality improvement initiatives
• Patient & Employee satisfaction initiatives
• Identifies barriers/delays and develops & implements strategies for resolution
• Progressive disciplinary process
• Performance improvement participation
• Revenue Cycle activities
• UR Plan preparation
• Discharge planning and strategies to manage barriers
• Discharge notices, and patient appeal process
• Identifies staff learning needs and provide training/ in-services- as needed
• Strategies to Care Manage patients across the continuum of care
• Data collection and analysis to drive improvements
• Reports preparation & worklist management
• Productivity, quality of care/ service metrics of staff and department
• Staff assignment, schedule, time sheets, payroll
• System implementation and training
• Participates in special projects and performs other related duties

Minimum Qualifications

* Qualification for Central Office.
# Qualification for Health Care Facility.
1. a. A Baccalaureate Degree in Public Administration, Public Health or Health Care Specialization; and,
b. Five* years or four# years of increasingly responsible experience in hospital administration, with particular emphasis on development and evaluation of health care delivery services; or,
2. a. A Master's Degree in Public Administration, Public Health or Health Care Specialization; and,
b. Four* years or three# years of increasingly responsible experience in hospital administration, with particular emphasis on development and evaluation of health care delivery services.

Department Preferences

• A valid New York State license and current registration to practice as a Registered Professional Nurse in New York State Preferred.
• A Master's Degree in Nursing Administration, Education or an equivalent field and a minimum of six years of satisfactory nursing experience, of which four years shall have been in a supervisory, teaching or administrative capacity preferred.

NYC Health and Hospitals offers a competitive benefits package that includes:

• Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
• Retirement Savings and Pension Plans
• Loan Forgiveness Programs for eligible employees
• Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
• College tuition discounts and professional development opportunities
• Multiple employee discounts programs

Vacancy Control Board Number

VCB #: KIN-05072024-1262