Registered Nurse Care Coordinator

2 months ago

White Plains, New York, United States ATC White Plains Full time
Position Overview

The Clinical Case Manager plays a crucial role in conducting thorough initial evaluations upon patient admission, adhering to the policies of the Care Management Department. This position involves screening patients using established tools to identify high-risk indicators, ensuring that vulnerable patient populations receive the necessary support services for a successful discharge and to mitigate the risk of readmission. Continuous reassessment of patient needs throughout their hospital stay is a key responsibility.

Key Responsibilities:
  1. Comply with Hospital Performance Standards, Policies, and Behaviors.
  2. Conduct comprehensive initial assessments for all patients.
  3. Facilitate multidisciplinary care coordination both within the hospital and with external facilities.
  4. Oversee transitional planning activities, which include:
    • Patient and caregiver education
    • Arranging aftercare services
    • Engaging with commercial payers
    • Identifying root causes for high utilization patients
  5. Effectively communicate and share relevant patient information with the healthcare team.
  6. Achieve departmental goals related to length of stay reduction, readmission prevention, denial management, and patient satisfaction enhancement.
  7. Document all activities in accordance with departmental standards.
  8. Participate in Performance Improvement initiatives as required.
  9. Conduct Utilization Review activities in line with departmental policies, including:
    • Commercial payer evaluations
    • Determining patient disposition
    • Conducting audits
    • Reviewing medical necessity variances
    • Performing clinical reviews upon admission.
  10. Execute any other related duties as assigned.
Qualifications:
  • Bachelor's degree in Nursing (BSN) or a related field is required.
  • A minimum of 5 years of clinical experience in emergency, critical care, or medical/surgical settings is required.
  • Prior experience in case management is preferred.
  • Familiarity with healthcare financial, regulatory, and payer issues is advantageous.
  • Knowledge of state, local, and federal healthcare programs is strongly preferred.
  • Experience with Milliman/InterQual criteria is beneficial.
  • A valid Registered Nurse (RN) license in New York State is mandatory.
  • Certification in PRI/Screen is strongly preferred.
  • Certification as a Certified Case Manager (C.C.M.) is preferred.
  • Proficient computer skills are essential.
Core Competencies:
  • Ability to establish effective two-way communication by clearly defining expectations and actively listening to concerns.
  • Demonstrated capability to delegate responsibilities appropriately.
  • Ability to maintain composure under pressure and manage multiple tasks effectively.
Physical and Mental Demands:
  • May be exposed to various chemicals necessary for job functions, with access to Safety Data Sheets available through the hospital's resources.
  • Must be capable of walking, standing, and/or sitting for extended periods, and able to carry necessary equipment during rounds.
  • Ability to perform complex manipulative tasks requiring hand-eye coordination and arm-hand steadiness.
  • Must meet all regulatory requirements and demonstrate the ability to follow both written and verbal instructions.
  • Ability to analyze complex problems and prioritize tasks effectively.
  • Must possess visual acuity and auditory skills to communicate effectively.
Target Population:

This position serves a diverse range of populations, including:

  • Neonates (birth – 28 days)
  • Patients with exceptional communication needs
  • Infants (29 days – less than 1 year)
  • Patients with developmental delays
  • Pediatrics (1 – 12 years)
  • Patients at end of life
  • Adolescents (13 – 17 years)
  • Patients under isolation precautions
  • Adults (18 – 64 years)
  • Patients with cultural needs
  • Geriatrics (65 years and older)

The responsibilities outlined in this job description are not exhaustive and may evolve based on the needs of the organization.

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