RN Case Manager- Per Diem

RN Case Manager

At Stony Brook Medicine, a TH Staff Associate/Case Manager is a valuable member of our team, who provides clinical services to our patient population. Qualified candidates will demonstrate superior patient care and possess outstanding communication skills while adhering to our high standard of excellence. Duties of a TH Staff Associate/Case Manager in the Care Management Department may include the following but are not limited to:

• Completes Utilization review screen for inpatient and observation cases.
• Activity includes UR from the Emergency Room or on the unit to ensure guidelines are reviewed and the plan of care is discussed with the team.
• Works closely with the Case Managers and Social Workers on the units and reviews findings with them.
• Ensures that patients are placed in the correct level of care from initial assess point.
• Follows cases for authorization for in patient stay.
• Staff review short stay, long stay and complex cases to affect and ensure a safe discharge plan.
• Completes retrospective review, one and two day short stay reviews and other projects as assigned.
• Identifies, follows and documents Avoidable delays in Care Management Program.
• Reviews and documents on patients who were readmitted within thirty days.
• Documents over utilization of resources and services.
• All Medicare cases are reviewed for level of care on admission.
• Reviews with the Attending, any patient who does not meet in-patient criteria for admission.
• Follow the process for Code 44 on Medicare patients.
• Follow the process for Code 44 on all other payers.
• Active participation with the physician and payer to prevent denials.
• Reviews cases for potential change in level of care with the CM and physician.
• Communicates with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals.
• Consistent documentation in the EMR regarding acuity, plan of care and communication with the team.
• Charting includes data for authorization and data management.
• Reviews cases daily from admission through discharge to prevent denials.
• This includes patient and family contacts, insurance authorizations, tests, procedures, community resources etc.
• Assistants with coordination for discharge planning including patient and family education with the interdisciplinary team.
• Coordinates transitional care planning for outpatient resources, prepares PRI for early referrals and contacts with agencies and facilities throughout the hospital stay.
• Actively involved in performance improvement activities including program development, data collection and analysis.
• Maintain high level customer service.
• All unit coverage as needed and other duties as required.

Qualifications Required: A Bachelor's degree or a nurse working on their degree with an RN license and working history of 5 years in hospital setting. A candidate should have a good understanding of the admission/discharge process. They need good interpersonal skills to work with all team members. They need to document accurately and be able to prioritize their work and follow up with cases.

Preferred: CM, UM, Quality, Coding, Risk or MCG Certification Working knowledge of MCG or Interqual PRI Certified Knowledge of regulatory requirements Bilingual Recent experience in tertiary care Experience in pediatrics, NICU, Mother/Baby or ED Leadership skills Master's prepared.

Please Note: Verification of degree (e.g., diploma or official transcript) is required for this role. Upload of documentation must be included with your application for consideration.

Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises. All Hospital positions maybe subject to changes in pass days and shifts as necessary. This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair. This function/position maybe designated as "essential." This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.

Prior to start date, the selected candidate must meet the following requirements: Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services Complete electronic reference check with a minimum of three (3) professional references. Successfully complete a 4 panel drug screen Meet Regulatory Requirements for pre employment screenings. Provide a copy of any required New York State license(s)/certificate(s). Failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.

Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.