Care Manager (RN) **Hospital Care Management Experience Highly Preferred**

NYU Langone Hospital—Long Island is a 591‑bed university‑affiliated medical center offering advanced diagnostic and therapeutic care in virtually every specialty. The organization is committed to medical education and research, and values equity and inclusion. Position Summary We have an exciting opportunity to join our team as a Care Manager (RN). Hospital Care Management Experience Highly Preferred . In this role, the successful candidate coordinates and procures services necessary to meet the post‑acute care needs of patients identified as requiring such services. The candidate ensures a timely and smooth transition to the most appropriate post‑acute care setting, works collaboratively with internal and external interdisciplinary team members, participates in quality improvement and evaluation processes, and maximizes provider reimbursement of patient days through timely and accurate insurance reviews. Job Responsibilities Performs other duties as assigned. Performs an initial utilization review of patients for appropriateness of setting using industry‑standard criteria including InterQual and Milliman Care Guidelines, and collaborates with attending physicians and physician advisors for review of patients not meeting criteria. Provides patient clinical reviews to payer in a timely manner to obtain certification of patient days and secure reimbursement; mediates concurrent denials with attending physicians and multidisciplinary team. Screens all inpatients for potential post‑acute care needs, performs assessment for discharge needs, develops discharge plans with patients or designees, and implements plans with necessary referrals. Completes all necessary documentation per departmental policy using Allscripts; completes Patient Review Instrument accurately and promptly. Identifies and reports risk and quality issues to the appropriate department; tracks avoidable days to identify improvement opportunities. Provides patients with required notices in accordance with CMS and payer contracts; processes Medicare Code 44 when appropriate; explains billing status to patient or designee. Participates in interdisciplinary meetings to assess clinical status, plan of care, and expected discharge date; facilitates communication among team members and resolves barriers or concerns. Participates in in‑service activities and continuing education programs as scheduled. Minimum Qualifications Bachelor’s degree in Nursing (required for employees hired after 9/1/2020). Current and valid New York State Registered Nurse License. Basic Life Support certification issued by the American Heart Association. 3–5 years of clinical acute‑care experience. Excellent oral and written communication, interpersonal, and organizational skills. Knowledge of clinical standards of practice for multiple patient populations. Computer skills. Registered Nurse License – NYS. Preferred Qualifications New York State Department of Health Patient Review Instrument assessor. 3–5 years of discharge planning and/or utilization management experience. Knowledge of post‑acute care referral process and procurement of patient services. Knowledge of hospital reimbursement process, insurance denials, and appeals. Qualified candidates must be able to effectively communicate with all levels of the organization. NYU Langone Hospital—Long Island is an equal‑opportunity employer and is committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration. NYU Langone Health provides a salary range of $147,153.96 – $149,195.34 annually. Actual salaries depend on experience, specialty, education, and hospital need. The salary range does not include bonuses, differential pay, or other forms of compensation. To view the Pay Transparency Notice, consult the appropriate resources. #J-18808-Ljbffr NYU Langone Hospitals