Registered Nurse, Care Manager, Day Shift on Site Position

3 weeks ago


New York, United States NYU Langone Medical Center Full time
  • In this role, the successful candidate Coordinates, negotiates, procures, and manages the care of patients by providing focused care coordination across the acute care continuum.
  • Communicates the outcome of chart review and managed care company telephonic review with the health care team as appropriate.
  • Conducts accurate reviews using CMS, Milliman Care Guidelines and the patients chart as the primary source of information.
  • Assesses patient and medical record documentation to identify medical necessity and appropriateness of admission and continued stay using pre-established clinical criteria (i.e., Milliman Care Guidelines, CMS) according to hospital policy.
  • Documents assessments, findings, progress, interventions and recommendations in Canopy and ECIN Care Management and ICIS systems within established timeframes.
  • Demonstrates an understanding of CMS, Milliman Care Guidelines relative to the patients diagnosis and condition when providing a clinical review to the payor to prevent a potential denial.
  • Documents a potential event/occurrence and communications to the Risk Manager into Canopy within established timeframes.
  • Knowledge of Microsoft Office and demonstrated proficiency in managing software such as Eclipsys Sunrise Manager, Canopy, and ECIN.


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