RN - Case Manager

RN Care Manager

Job Title: RN Care Manager

Profession: Registered Nurse

Specialty: Care Management

Duration: 13 weeks

Shift: 10H Days

Hours per Shift: 38 hours per week

Experience: Minimum of 2 years

License: NYS Registered Nurse license required

Certifications: BLS (AHA), PRI Certification (to be obtained within 3 months of employment), Care Management certification preferred (i.e., CMC, CCM, etc.)

Must-Have: Discharge experience required. Knowledge of healthcare financial, regulatory, and payer issues preferred. Knowledge of state, local, and federal programs strongly preferred. Experience with Milliman/InterQual criteria. Computer skills essential.

Description: The RN Care Manager performs an initial comprehensive assessment on admission in accordance with department policy. All patients are screened using established tools for high-risk indicators to ensure high-risk patient populations receive appropriate supportive services for discharge to prevent readmission. Ongoing reassessment of needs throughout the hospital course is performed. The RN Care Manager performs Utilization Review activities per department policy. Essential functions and responsibilities include: Understanding and adhering to performance standards, policies, and behaviors. Completing a comprehensive initial assessment. Performing all activities for multidisciplinary care coordination at both intra-hospital and inter-hospital levels. Carrying out all transitional planning activities, including patient/caregiver education and arranging aftercare. Involving commercial payers and addressing high-utilizer patient root causes. Communicating and collaborating all relevant patient information with appropriate health team members. Ensuring department goals of length of stay reduction, readmission prevention, denial reduction, and improvement in patient satisfaction are achieved. Documenting per department requirements. Participating in performance improvement activities as needed. Performing all Utilization Review activities according to department policy, including commercial payer reviews and clinical admissions review. Collaborating with healthcare professionals to evaluate the needs and ensure the safe discharge of all patients, including inpatients, emergency department, and surgical outpatients. Performing all other related duties as assigned.