RN Care Manager

In-Office | White Plains, NY, United States

Overview

The Clinical Coordinator / RN Care Manager performs the initial comprehensive assessment on admission in accordance with the Care Management Department policy, screening all patients by utilizing established tools for high-risk indicators to ensure high-risk patient populations receive the appropriate supportive services for discharge to prevent readmission and assess all populations for potential discharge planning needs. Provides ongoing reassessment of needs throughout the hospital course. Performs UR activity per department policy.

What you will be doing

• Understands and adheres to the WPH Performance Standards, Policies, and Behaviors.
• Completes a comprehensive initial assessment.
• Performs all activities for multidisciplinary care coordination at the intra-hospital level of care and inter-hospital level of care.
• Performs all transitional planning activities including patient/caregiver education, arrangement of aftercare, commercial payer involvement, high utilizer patient root cause analysis.
• Communicates and collaborates all relevant patient information to appropriate health team members.
• Ensures department goals of LOS reduction, readmission prevention, denial reduction, and satisfaction improvement are realized.
• Participates in Performance Improvement activities as needed.
• Commercial payer reviews.
• Retro/self-audit.
• MC variance.
• Admission clinical review.
• The RN Care Manager collaborates with all health care professionals to evaluate the needs and the safe discharge of all geriatric patients including inpatients, emergency department, and surgical outpatients.
• Performs all other related duties as assigned.

What you must have

• BSN required.
• Licensure: Registered Nurse (RN) NYS license required.
• Certifications: PRI Certification (must be obtained within 3 months of initial employment). Screen certification (strongly preferred).
• Clinical Experience: 3 years clinical ED, critical care, or med/surg experience preferred.
• Technical Knowledge: Knowledge of healthcare financial, regulatory, and payer issues preferred.
• Knowledge of state, local, and federal programs strongly preferred.
• Experience in use of Milliman/InterQual criteria.