Nurse Case Manager
5 days ago
Montefiore Medical Center is seeking a skilled Nurse Case Manager to join our team. As a key member of our healthcare team, you will play a vital role in ensuring the delivery of high-quality patient care and optimizing resource utilization.
Key Responsibilities- Coordinate the continuum of medical care services for patients to ensure optimal utilization of resources and delivery of 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.
- BSN or a bachelor's degree in a related field required; Master's preferred.
- NYS RN License required.
- PRI assessor number required prior to end of 3-month probationary period.
- 3-5 years recent acute care clinical experience preferred.
- Experience in utilization management preferred.
- Experience in a managed care organization preferred.
- Certification in Utilization Review or Case Management preferred.
- 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.
- 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 in the use of Windows-based software applications.
- Experience in the use of an electronic clinical information system preferred.
- Excellent verbal, written, and interpersonal communication skills, as well as a commitment to interdisciplinary teamwork.
- Excellent organization skills, teamwork skills, 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.
- A dynamic and supportive work environment.
- Opportunities for professional growth and development.
- A competitive salary and benefits package.
Montefiore Medical Center is a leading academic medical center and one of the nation's largest healthcare providers. We are committed to delivering high-quality patient care and advancing the field of medicine through innovative research and education.
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