Registered Nurse Case Manager

About the role

Serves as liaison between the patient and facility/physician. Ensures a continuum of quality patient care throughout hospitalization and oversees provisions for patient's discharge. Assesses, plans, oversees and evaluates the appropriateness of care throughout admission and hospitalization of the patient.

Responsibilities

• Facilitates patient management throughout hospitalization.
• Performs concurrent utilization management using evidence based medical necessity criteria.
• Submits data to management regarding case management and/or quality initiatives.
• Serves as an in-patient liaison - planning, assessing, implementing and evaluating patient in collaboration with the health care team.
• Conducts chart review for appropriateness of admission and continued length of stay; facilitates throughput.
• Conducts clinical reviews and interacts with third party payers to obtain approval of hospital days, pre-certification and post-discharge eligibility in relation to clinical course.
• Ensures compliance with current state, federal, and third party payer regulations.
• Documents the case management process in the medical record; completes and documents a care coordination assessment on the patient.
• Serves as a liaison to patient, family, admitting, primary care physician, health care team, and hospital departments.
• Completes applicable areas of the patients discharge instruction sheet and the patient transfer sheet; ensures case management documentation is current and accurate.

Requirements

• Graduate from an accredited School of Nursing.
• Must be enrolled in an accredited BSN program within two (2) years and obtain a BSN Degree within five (5) years of job entry date.
• Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed.

Qualifications

• Emergency Department experience, preferred.
• Knowledge of Milliman guidelines, preferred.
• Two years of experience in an acute care setting, preferred.
• Ability to manage a diverse caseload, including complex discharge planning needs.
• Strong time management, workflow, critical thinking and conflict resolution skills.
• Team-oriented; able to coordinate self-scheduling collaboratively.
• Flexible to float as needed.