RN/Case Manager-Mount Sinai Morningside Case Management (ED)-FT-Nights (12hr/shifts)

About the role

The Case Manager (CM) will be responsible for all aspects of case management for an assigned group of inpatients to determine the appropriateness of the admission and continued stay, assist in the development of the plan of care; ensure that the plan is implemented in a timely basis and identify the expected length of stay (ELOS). The CM works collaboratively with physicians, social workers, clinical nurses, home care services, and other members of the interdisciplinary team as needed. The CM actively participates in specific clinical initiatives focused on reducing the length of stay (LOS), improved efficiency, quality and resource utilization.

Responsibilities

• Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve optimal patient outcomes and appropriate reimbursement for the organization.
• Performs continued stay reviews utilizing standardized criteria to justify continued inpatient stay.
• Collaborates with Physician and other clinicians to expedite diagnostic testing, treatment and consultations.
• Documents all clinical reviews in Canopy.
• Supports the mission, vision, philosophy and goals of the Medical Center.
• Case Management: The CM process will include:
• Assessment of the patient’s clinical, psychosocial, and functional status in collaboration with the interdisciplinary team.
• Identification and documentation of variances affecting the LOS and the discharge planning process.
• Conducts follow-up of any delays in treatment or reporting of results.
• Planning/developing specific goals with the physician, interdisciplinary team, and the patient and/or family.
• Implementation and coordination of specific activities, strategies, and interventions to move the patient through the continuum of care.
• Documentation of outcomes achieved and identified internal and external barriers.
• Identifies reasons for readmissions and collaborates with interdisciplinary team on strategies to reduce readmission rate.
• Appropriately identifies and refers cases to the physician advisor to support timely progression of patients along the continuum of care and (appropriate) discharge planning.
• Interacts with patient/family to discuss plan of care and coordination of services based on clinical needs and available resources.
• Utilization Review: Maintains a working knowledge of the UR requirements of each payor within the patient population; Provides the clinical information requested by the managed care companies as part of the concurrent review in a timely fashion. Communicates clinical information to the payor, as needed, coordinating direct communication between physician and payor Medical Director as required.
• Discharge Planning: Responsible for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission).
• Obtains authorizations from managed care companies for post-discharge services. Assesses for clinical readiness and completes the Hospital and Community Patient Review Instrument (PRI) for patients requiring Residential Health Care Facility placement. Liaison with financial department for current insurance coverage.
• Collaborates and participates in the appeals process with all members of the interdisciplinary team.

Requirements

• Bachelor’s Degree in Nursing; Masters preferred.
• Previous experience as in homecare, long term care or utilization review preferred.
• Discharge Planner or Case Manager preferred.
• Manager or a minimum of 3-5 years’ experience as a RN in an acute care setting.
• Current NYS RN nursing license.
• CCM certification preferred.

Qualifications

• Collective bargaining unit: NYSNA-SLW
• Employer Description
• Strength through Unity and Inclusion
• The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai’s unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual. At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally.

Benefits

Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.