Registered Nurse Care Manager

Key Responsibilities:

Comprehensive Assessments: Perform initial and ongoing comprehensive clinical evaluations upon admission to identify specific discharge needs and track progress throughout the hospital course.

Multidisciplinary Coordination: Manage all facets of care coordination at both the intra-hospital and inter-hospital levels, working closely with an integrated health team.

Transitional Planning: Design and execute complex discharge and transitional care plans, including arranging necessary aftercare, leading patient/caregiver education, and managing commercial payer involvement.

High-Risk Intervention: Perform root-cause analysis for high-utilizer patient populations to deploy preventative strategies and reduce readmission rates.

Utilization Review (UR): Conduct thorough clinical reviews using established guidelines (such as Milliman or InterQual) to manage commercial payer reviews, disposition determination, retro/self-audits, and admission clinical assessments.

Geriatric Advocacy: Collaborate across specialties to evaluate the specific needs and safe discharge pathways for geriatric patients across inpatient floors, the Emergency Department, and surgical outpatient settings.

Quality & Performance: Actively document care milestones per department compliance standards and participate in targeted performance improvement activities.

Other duties as assigned.

Required Qualifications

Experience: Minimum of 3 years of clinical acute care experience required.

Education: Bachelor of Science in Nursing (BSN) required.

Licensure: Curre nt New York State (NYS) Registered Nurse License required.

Certification: Must obtain PRI Certification within three (3) months of initial employment.

Technical Literacy: Essential computer proficiency and data entry skills required.

Desired Qualifications

Clinical Specialty: 3 years of clinical experience specifically within an Emergency Department (ED), Critical Care, or Medical-Surgical environment is highly preferred.

Case Management Background: Previous dedicated case management experience within an acute care hospital setting.

Specialty Certifications: Active Care Management credentialing (e.g., CCM, CMC) and Screen Certification are strongly preferred.

Industry Acumen: Comprehensive knowledge of healthcare financial structures, state/federal/local regulatory programs, and commercial payer issues.

System Knowledge: Hands-on experience utilizing InterQual or Milliman Criteria for utilization review.

Location and Work Type

Work Setting: Hospital-Based Case Management Department

Location: White Plains, NY area

Work Type: Full-Time | Direct Hire

Schedule: Monday – Friday | 9:00 AM – 5:00 PM (Day Shift)

Rotation: Saturday and Sunday rotation required once per month.

Benefits: Full suite of comprehensive health benefits and a competitive retirement plan.