Case Manager

Position Summary 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 Completes utilization review screens for inpatient and observation cases, ensuring guidelines are reviewed and the plan of care is discussed with the team. Works closely with case managers and social workers on units, reviewing findings and ensuring patients are placed at the correct level of care from initial assessment. Follows cases for authorization for inpatient stay and ensures correct level of care for all admissions, including Medicare and other payers. Staffs short stay, long stay, and complex cases, completing short‑stay reviews and other projects as assigned to identify and document avoidable delays and readmissions within 30 days. Participates actively with physicians and payers to prevent denials, reviewing cases for potential level‑of‑care changes. Communicates with transferring hospitals, patient access, physicians and payers for authorization prior to transfer from other hospitals. Maintains consistent documentation in the EMR regarding acuity, plan of care and communication with the team. Reviews cases daily from admission through discharge to prevent denials, including patient and family contacts, insurance authorizations, tests, procedures and community resources. Assists with coordination for discharge planning, including patient and family education, transitional care planning and coordination of outpatient resources. Acts actively in performance‑improvement activities including program development, data collection and analysis. Provides high‑level customer service and covers units as needed. Qualifications Required: A Bachelor’s degree or nursing degree with an RN license and five years of hospital‑setting experience; excellent interpersonal, documentation, prioritization and follow‑up skills. Preferred: Certification in CM, UM, Quality, Coding, Risk or MCG; working knowledge of MCG or InterQual; PRI certification; knowledge of regulatory requirements; bilingual; experience in tertiary care, pediatrics, NICU, mother‑baby or ED; leadership skills; master’s degree. Pay Range The salary range for this position is $89,760 – $127,975 base per year. Equal Opportunity Statement Stony Brook University is committed to excellence in diversity and 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. If you need a disability‑related accommodation, please call the University Office of Equity and Access at View phone number on click.appcast.io. #J-18808-Ljbffr Stony Brook Medicine