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Registered Nurse
2 months ago
Montefiore Medical Center is seeking a skilled Registered Nurse to fill a Case Management position. As a key member of our healthcare team, you will play a vital role in coordinating patient care services to ensure optimal resource utilization, quality patient care, and compliance with regulatory requirements.
Key Responsibilities- Coordinate the continuum of medical care services for patients to ensure efficient use of resources and delivery of high-quality patient care.
- Determine the appropriateness of patient care services and prepare clinical appeals for third-party denials.
- Collect and interpret data for utilization, compliance, quality improvement, and other areas as assigned.
- Develop and implement effective case management plans to ensure patient needs are met and care is delivered in a timely and efficient manner.
- Collaborate with healthcare professionals to ensure seamless patient care and effective communication.
- Stay up-to-date with regulatory requirements, industry trends, and best practices in case management.
- Bachelor's degree in Nursing or a related field required; Master's degree preferred.
- Current New York State RN license required.
- PRI assessor number required prior to the end of the 3-month probationary period.
- 3-5 years of recent acute care clinical experience preferred.
- Experience in utilization management and case management preferred.
- Certification in Utilization Review or Case Management preferred.
- Excellent analytical, problem-solving, conflict resolution, and negotiation skills.
- Demonstrated knowledge of federal, state, and commercial/third-party regulations related to utilization management functions, discharge planning, and associated processes.
- Demonstrated knowledge of quality/performance improvement tools and techniques.
- Demonstrated knowledge of utilization and case management principles.
- Experience in the application of utilization management decision support criteria preferred.
- Computer skills, including data entry, word processing, and electronic messaging.
- Experience with Windows-based software applications.
- Experience with electronic clinical information systems preferred.
- Excellent verbal, written, and interpersonal communication skills, as well as a commitment to interdisciplinary teamwork.
- Excellent organization, teamwork, and time management skills.
- Expert clinical knowledge of disease processes to identify care needs.
- Understanding of the healthcare delivery system and its sites of care, delivery models, and the roles of various providers and healthcare professionals.
- Experience in interpreting and applying benefit coverage rules and assessing coordination of benefits guidelines and managed care regulations required.
Montefiore Medical Center is a leading academic medical center and one of the nation's largest healthcare providers. We are committed to delivering exceptional patient care, advancing medical research, and educating the next generation of healthcare professionals.
Compensation Information$61.68 per hour
