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 care in collaboration with the healthcare 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, healthcare team, and hospital departments.
• Completes applicable areas of the patient’s discharge instruction sheet and the patient transfer sheet; ensures case management documentation is current and accurate.
• Manages a caseload of adult inpatients, coordinating care from admission through discharge with confidence and clinical insight.
• Engages in complex discharge planning, collaborating with interdisciplinary teams to ensure seamless transitions and continuity of care.
• Partners with your team and coworkers to coordinate scheduling, supporting one another to maintain balanced and effective coverage.
• Adapts and contributes across units by floating to areas of need, broadening skills and strengthening department-wide care delivery.
• Shares in weekend and holiday rotations on an alternating basis, ensuring consistent, high-quality support through self-scheduling.
• Performs utilization management using Milliman guidelines and assessing medical necessity criteria.
• Collaborates with interdisciplinary team including daily rounds, participation in family meetings, and staff meetings.
• Completes PRI’s (Patient Review Instrument).

Requirements

• Graduate from an accredited School of Nursing. Bachelor’s Degree in Nursing, preferred. 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.
• 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.
• Flexibility in days as needed.
• Alternating weekends and holidays.

Pay

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget, and internal equity).