RN Care Manager

Job Description

Job Description

RN Care Manager Role Summary

Synthesize your strong clinical expertise with strategic resource utilization as an RN Care Manager. In this essential role, you will act as a primary champion for seamless patient transitions and care optimization within a premier, forward-thinking healthcare facility. You will conduct comprehensive clinical assessments upon admission, leveraging industry-standard criteria to screen for high-risk indicators and ensure vulnerable populations receive customized supportive services. By driving intra-hospital care coordination and navigating complex Utilization Review (UR) activities, you will directly influence critical hospital metrics—including reducing length of stay (LOS), preventing readmissions, mitigating insurance denials, and championing patient satisfaction.

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.

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!