RN/Case Manager-MSH-Case Management-FT-Weekdays/Weekends/Holidays

RN/Case Manager MSH Case Management FT Weekdays/Weekends/Holidays The Case Manager (CM) is responsible for all aspects of case management for an assigned group of patients. The CM determines the appropriateness of the level of care, assists in developing the plan of care, ensures timely implementation, and identifies the expected length of stay (ELOS). The CM works collaboratively with physicians, social workers, clinical nurses, home‑care services, and other members of the interdisciplinary team. The CM actively participates in clinical initiatives focused on reducing length of stay, improving efficiency, quality, and resource utilization. Responsibilities Review all new admissions to identify patients needing utilization review, discharge planning, and/or case management using standardized criteria. Perform continued stay reviews using standardized criteria to justify continued inpatient stay. Collaborate with physicians and other clinicians to expedite diagnostic testing, treatment, and consultations. Document all clinical reviews in the Case Management Documentation system. Support the mission, vision, philosophy, and goals of the Medical Center. Assess patients’ clinical, psychosocial, and functional status in collaboration with the interdisciplinary team. Identify and document variances affecting LOS and discharge planning. Follow up on delays in treatment or reporting of results. Plan and develop specific goals with the physician, interdisciplinary team, and patient/family. Implement and coordinate activities, strategies, and interventions to move the patient through the continuum of care. Document outcomes achieved and identify internal and external barriers. Identify reasons for readmissions and collaborate with the interdisciplinary team to reduce readmission rates. Refer cases to the physician advisor as appropriate to support timely progression and discharge planning. Interact with patient/family to discuss the plan of care and coordinate services based on clinical needs and available resources. Maintain knowledge of UR requirements of each payor within the patient population. Provide clinical information requested by managed care companies for concurrent review in a timely manner. Cooperate with physicians and managed care companies on concurrent denial appeals. Communicate clinical information to payors as needed, coordinating direct communication between physicians and payor Medical Directors when required. Document UR notes in the medical record as per OMH guidelines in psychiatry. Assess, communicate, and monitor the discharge planning process. Obtain authorizations from managed care companies for post‑discharge services. Complete the Hospital and Community Patient Review Instrument (PRI) for patients requiring Residential Health Care Facility placement. Liaise with the financial department regarding current insurance coverage. Collaborate and participate in the appeals process with all interdisciplinary team members. Develop and maintain effective working relationships with the interdisciplinary team and case managers within managed care organizations. Participate in nursing orientation. Interface with other departments in the Medical Center. Qualifications Education Requirements Bachelor’s Degree in Nursing; Master’s preferred. Experience Requirements Previous experience in home‑care, long‑term care or utilization review preferred. Experience as a discharge planner or case manager preferred. Minimum of 3–5 years as a RN in an acute‑care setting. Licensing and Certification Requirements Current NYS RN nursing license. CCM certification preferred; re‑credentialing expected. PRI certification to be obtained within 1 year. BLS certification (issued by AHA). Equal Opportunity Employer The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. Compensation Hourly salary range: $65.81 – $65.81 per hour. #J-18808-Ljbffr Mount Sinai Morningside