Cheryl Hofmann

Experience

• 

  Cohen Children's Medical Center of New York

  Jul 1999 - Jan 2012

  • Reviews and coordinates utilization issues concurrently and retrospectively related to potential denials from managed care and third party reviewers. • Assists with planning and implementation of patient care across the continuum. Maintains data tracking systems and provides reports to Patient Accounts, Director of Care Coordination, and Medical Director. • Writes first and second level insurance appeal letters Reviews and coordinates utilization issues concurrently and retrospectively related to potential denials from managed care. • Promotes staff development and education. Participates in departmental continuous quality improvement activities and committees. • Coordinates department Performance Improvement initiative on readmissions, identifying patterns or trends which contribute to unnecessary readmissions. • Coordinate, monitor and report on department outcomes, identifying patterns and trends as they relate to i.e.: discharge planning, length of stay, clinical reviews, etc. Show less • Responsibilities include promoting appropriate quality patient care and effective utilization of available health resources along the continuum of care from admission through post discharge. • To assess, and initiate an individualized a safe and appropriate discharge plan in a timely fashion for each patient. This is done in conjunction with the physicians, nurses, social workers, patients, and their families to ensure the post hospital needs are met appropriately. • To provide review of medical records to assure the appropriateness and necessity of the admission at the most efficient level of care, regardless of payment source. • Coordinating department Performance Improvement initiative on readmissions, identifying patterns or trends which contribute to unnecessary readmissions. • Working with supervisor to during pre-development phase of AllScripts/Canopy program. Learning all aspects of program as a super-user, then working to co-ordinate and work with both RN and Social Work staff education for program use, and ongoing utilization. This was again repeated with the inception of the AllScripts ECIN program. As of June 2009 the hospital went to electronic charting, and I function as department super-user for the new electronic medical record program (Eclypsis). Show less

  • Appeals Case Manager

    Jul 2010 - Jan 2012

  • RN Case Manager

    Jul 1999 - Jul 2010
• 

  Cohen Children's Medical Center

  Jan 2012 - now

  • Manages the daily operations of Case Management Department and Case Management staff. Ensures delivery of care, productivity and timeliness. • Ensures staff is informed of changes impacting their work by communicating updates, policy revision, performance outcomes and significant events. Evaluates Case Managers practice for quality, timelines and process consistency. • Coordinates staff orientation and training programs. Documents and assesses effectiveness of staff training. Ensures staff provides case management within scope of practice in compliance with Department protocols. • Develops Case Management reports to report Departmental outcomes, trends and issues Show less • Manages appeals process. Acts as a hospital liaison to third party reviewers. Coordinates and manages utilization issues concurrently and retrospectively as they relate to potential denials related to IPRO, managed care and third party reviewers. • Assists with planning and implementation of patient care across the continuum. Maintains data tracking systems and provides reports to Patient Accounts, Director of Case Management, and Medical Director. Monitors inpatient denials and assists patients and physicians with management of the appeals process. • Assists the Director of Case Management in developing new programs to enhance resource management and quality patient care. • Promotes staff development and education. Provides opportunities for formal and informal education to promote staff competency. Sets standards for performance and provides ongoing feedback to staff. • Participates in departmental continuous quality improvement activities and committees. Performs related duties, as required. • Coordinate department Performance Improvement initiative on readmissions, identifying patterns or trends which contribute to unnecessary readmissions. Coordinate, monitor and report on department outcomes, identifying patterns and trends as they relate to ie: discharge planning, length of stay, clinical reviews, etc. Show less

  • Director of Case Management

    Feb 2015 - now

  • Assistant Director Case Management

    Dec 2013 - now

  • Assistant Director Appeals Management

    Jan 2012 - Dec 2013
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  Peconic Bay Medical Center

  Jul 2019 - now

  Case Manager