RN Case Manager

Job Description

Job Description

 

RN Care Manager - Role Summary

The RN Care Manager plays a critical role in coordinating safe, effective, and patient-centered care across the continuum of hospital services. This position focuses on comprehensive assessment, care coordination, utilization review, and discharge planning to reduce readmissions, improve outcomes, and enhance patient and caregiver satisfaction. Working closely with interdisciplinary healthcare professionals, the RN Care Manager supports complex patient populations—particularly geriatric patients—by ensuring timely access to appropriate post-acute services and resources.

This role is ideal for experienced nurses who enjoy clinical problem-solving, collaboration, and making a measurable impact on patient outcomes and care efficiency.

 

Key Duties & Responsibilities

• Complete comprehensive initial patient assessments in accordance with Care Management policies

• Perform multidisciplinary care coordination across intra-hospital and inter-hospital levels of care

• Lead transitional care planning activities, including:

  • Patient and caregiver education

  • Coordination of post-acute and aftercare services

  • Collaboration with commercial payers

  • Evaluation of high-utilizer patient root causes

• Communicate and collaborate relevant patient information with appropriate members of the healthcare team

• Support departmental goals related to length-of-stay reduction, readmission prevention, denial reduction, and patient satisfaction improvement

• Complete documentation in accordance with departmental standards

• Participate in performance improvement initiatives as needed

• Perform utilization review (UR) activities in alignment with departmental policy, including:

  • Commercial payer reviews

  • Disposition determinations

  • Admission clinical reviews

  • Retroactive and self-audits

  • Medical necessity variance analysis

• Collaborate with healthcare professionals to evaluate care needs and ensure safe discharge planning for geriatric patients across inpatient, emergency department, and surgical outpatient settings

• Perform additional related duties as assigned 

Required Education & Experience

• Bachelor of Science in Nursing (BSN) required

• Active Registered Nurse (RN) license in the state of practice

• PRI Certification (must be obtained within three months of hire)

• Strong computer proficiency

Desired Qualifications

• Screen Certification (strongly preferred)

• Care Management certification (e.g., CCM, CMC, or equivalent)

• Minimum of three (3) years of clinical experience in emergency, critical care, or medical-surgical nursing

• Prior case management experience

• Knowledge of healthcare finance, regulatory requirements, and payer systems

• Familiarity with state, local, and federal healthcare programs

• Experience using Milliman or InterQual medical necessity criteria

Core Competencies

• Strong two-way communication skills with the ability to clearly define expectations and actively listen

• Effective delegation and team collaboration skills

• Ability to remain composed under pressure and manage multiple priorities simultaneously

Physical & Mental Requirements / Work Environment

• Ability to walk, stand, and sit for extended periods of time

• Ability to carry necessary equipment (e.g., laptop or tablet) during rounds

• Adequate manual dexterity, hand-eye coordination, and visual and auditory acuity

• Ability to follow written and verbal instructions and meet regulatory requirements

• Exposure to standard healthcare-related chemicals in accordance with safety guidelines

• Ability to analyze complex, multidimensional problems and prioritize tasks effectively

Primary Patient Populations Served

• Adult (18–64 years)

• Geriatric (65+ years)

• Patients with complex medical, cultural, communication, developmental, or end-of-life care needs

• Patients under isolation precautions

• Bariatric patients with weight-related comorbidities

Location & Work Type

Location : White Plains, New York

Work Type: On-site

Schedule: Full-time, day shift

Monday–Friday, 9:00 a.m. – 5:00 p.m.

Weekend rotation once per month (Saturday and Sunday)

If you're interested, please reply to this advertisement or directly email your resume to me at View email address on us.fitly.work or by calling/texting View phone number on us.fitly.work.

I strive to reply within 48 hours. Looking forward to connecting with you soon. Thank you!