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RN Case Manager

4 weeks ago

New York, New York, United States Memorial Sloan Kettering Full time

Job Summary:

Memorial Sloan Kettering is seeking a skilled RN Case Manager to join our Inpatient Case Management Department. As a key member of our team, you will be responsible for evaluating and responding to clinical and administrative denials referred to Case Management for appeal.

Key Responsibilities:

  • Evaluate and respond to clinical and administrative denials referred to Case Management for appeal
  • Participate in the daily management of denials through resolution after appeal is filed
  • Perform special chart reviews to support strategic planning initiatives
  • Act as a liaison to insurance carriers and staff
  • Provide case management for a caseload of Oncology patients
  • Assess discharge planning needs at patient admission
  • Perform regular concurrent review on all patients and coordinate needed services
  • Act as part of a multidisciplinary team to provide continuity of care
  • Connect with physicians and clinical nursing staff regarding ongoing patient care
  • Work with insurance carriers and MSKCC billing departments to initiate appeals and acquire authorizations for treatment

Requirements:

  • Current NYS Registered Nurse License/Registration and BSN preferred
  • At least 2-3 years of clinical hospital nursing experience
  • Managed care/UR/CM experience strongly preferred
  • Knowledge of state and federal regulations that govern health insurance coverage
  • Knowledge of Microsoft: Outlook, Word, Excel, and PowerPoint

What We Offer:

  • Competitive pay range: $108,400.00-$173,400.00
  • Monday - Friday, Five Days x 8 hours remote hybrid or Four Days x 10 hours onsite
  • Occasional Saturday work may be required
  • Training will be on site for the first 6+ months

About Memorial Sloan Kettering:

Memorial Sloan Kettering is a world-renowned cancer center dedicated to patient care, research, and education. Our team is united by a singular mission: ending cancer for life. We are committed to diversity and inclusion in all aspects of recruiting and employment.