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Nurse Case Manager

1 month ago


Watertown, Massachusetts, United States Northwell Health Full time
Job Summary

We are seeking a skilled Registered Nurse Case Manager to join our team at Northwell Health. As a key member of our healthcare team, you will be responsible for coordinating patient care and ensuring a seamless transition from hospitalization to discharge.

Key Responsibilities
  • Facilitate patient management throughout hospitalization, ensuring a continuum of quality care.
  • Perform concurrent utilization management using evidence-based medical necessity criteria.
  • Submit data to management regarding case management and/or quality initiatives.
  • Serve as an in-patient liaison, planning, assessing, implementing, and evaluating patient care in collaboration with the healthcare team.
  • Conduct chart reviews for appropriateness of admission and continued length of stay, facilitating throughput.
  • Interact with third-party payers to obtain approval of hospital days, pre-certification, and post-discharge eligibility in relation to clinical course.
  • Ensure compliance with current state, federal, and third-party payer regulations.
  • Document the case management process in the medical record, completing and documenting a care coordination assessment on the patient.
  • Serve as a liaison to patient, family, admitting, primary care physician, healthcare team, and hospital departments.
  • Complete applicable areas of the patient's discharge instruction sheet and the patient transfer sheet, ensuring case management documentation is current and accurate.
Requirements
  • Graduate from an accredited School of Nursing.
  • Bachelor's Degree in Nursing, preferred.
  • At least 5 years acute care nursing experience.
  • Prior Case Management and/or Utilization Review experience.
  • BLS certification.
  • PRI certification preferred.
  • Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed.