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Clinical Case Manager

2 months ago


Fort Lee, New Jersey, United States Montefiore Medical Center Full time
Job Summary

Montefiore Medical Center is seeking a skilled Clinical Case Manager to join our team. As a key member of our Utilization Management department, you will play a critical role in ensuring the optimal utilization of resources and delivery of quality patient care.

Key Responsibilities
  • Coordinate Continuum of Care: Work closely with patients, families, and healthcare providers to ensure seamless transitions and optimal care outcomes.
  • Utilization Review: Conduct thorough reviews of patient care services to identify opportunities for improvement and ensure compliance with regulatory requirements.
  • Clinical Decision Making: Utilize expertise in clinical decision-making to determine the appropriateness of patient care services and prepare clinical appeals for third-party denials.
  • Data Analysis: Collect and interpret data to inform utilization, compliance, quality improvement, and other initiatives.
  • Collaboration and Communication: Foster strong relationships with healthcare providers, patients, and families to ensure effective communication and coordination of care.
Requirements
  • Education: BSN or a bachelor's degree in a related field required; Master's preferred.
  • Licensure: NYS RN License required.
  • Experience: 3-5 years recent acute care clinical experience preferred; experience in utilization management and case management preferred.
  • Certifications: Certification in Utilization Review or Case Management preferred.
  • Skills: Analytical skills, problem-solving skills, 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.
What We Offer
  • Competitive Salary: $61.68 per hour.
  • Opportunities for Growth and Development: Montefiore Medical Center is committed to investing in the growth and development of our employees.
  • Diverse and Inclusive Work Environment: Montefiore Medical Center is an equal employment opportunity employer and values diversity and inclusion in the workplace.