RN Care Manager - Hospital Care Management

Job Description

Job Description

RN Care Manager – Hospital Care Management

Location: White Plains, NY

Schedule: Full-Time | Days

Hours: 9:00 AM–5:00 PM | Monday–Friday, with alternating weekends and holidays

Compensation: $65.00 –$81.00/hour

The Opportunity

We are seeking an experienced Registered Nurse Care Manager to join the Care Management team of an established acute care hospital in White Plains, New York.

The RN Care Manager plays an important role in coordinating patient care from admission through discharge. This position is responsible for comprehensive patient assessments, utilization review, discharge and transitional planning, and collaboration with physicians, nursing staff, patients, families, payers, and other members of the interdisciplinary care team.

The goal is to ensure patients receive the appropriate level of care while supporting safe discharges, reducing avoidable readmissions, improving length of stay, and minimizing payer denials.

Key Responsibilities

• Complete comprehensive initial patient assessments upon admission and identify patients with high-risk indicators or discharge planning needs.
• Continually reassess patient needs throughout the hospital stay.
• Coordinate multidisciplinary care at both the intra-hospital and inter-hospital levels.
• Develop and coordinate safe, appropriate discharge and transitional care plans.
• Provide patient and caregiver education and arrange necessary post-discharge services and resources.
• Collaborate closely with physicians, nursing, social work, ancillary departments, payers, patients, and families.
• Perform utilization review activities in accordance with established department policies.
• Conduct commercial payer reviews, admission clinical reviews, disposition determinations, retrospective reviews, self-audits, and variance reviews.
• Help achieve departmental goals related to reducing length of stay, preventing readmissions, reducing denials, and improving patient satisfaction.
• Evaluate the care and discharge needs of geriatric patients across inpatient, emergency department, and surgical outpatient settings.
• Maintain timely and accurate documentation of assessments, care coordination, utilization review, and discharge planning activities.
• Participate in performance improvement initiatives.

Qualifications

Required:

• Bachelor of Science in Nursing (BSN); MSN also accepted.
• Active New York State Registered Nurse license.
• Strong clinical nursing background.
• Ability to obtain PRI (Patient Review Instrument) Certification within 90 days of hire.
• Strong computer and documentation skills.

Preferred:

• Approximately 3 years of clinical nursing experience in Emergency Department, Critical Care, or Medical-Surgical nursing.
• Previous Case Management/Care Management experience.
• Experience using Milliman and/or InterQual criteria.
• Knowledge of healthcare financial, regulatory, and payer requirements.
• Knowledge of applicable state, local, and federal healthcare programs.
• New York State SCREEN certification.
• Care Management certification such as CCM or CMC.