Nurse Case Manager

4 weeks ago

White Plains, New York, United States White Plains Hospital Full time
Job Title:
Registered Nurse (RN)

Job Specialty:
Case Management (Utilization Review)

Job Summary:
White Plains Hospital seeks a skilled Registered Nurse to join our Case Management team. As a Nurse Case Manager, you will play a critical role in ensuring the highest quality patient care and outcomes.

Key Responsibilities:

  • Conduct comprehensive initial assessments on admission, utilizing established tools for high-risk patients.
  • Provide ongoing reassessment of patient needs throughout the hospital course.
  • Manage all activities for multidisciplinary care coordination within and between hospital levels of care.
  • Perform transitional planning activities, including patient/caregiver education, arrangement of aftercare, commercial payer involvement, and addressing high utilizer patient root causes.
  • Communicate patient information effectively to relevant health team members.
  • Work towards achieving department goals: length of stay reduction, readmission prevention, denial reduction, and satisfaction improvement.
  • Participate in Performance Improvement activities as needed.
  • Conduct Utilization Review activities per department policy: commercial payer reviews, disposition determination, retro/self audit, medical necessity variance, and admission clinical review.
  • Collaborate with healthcare professionals to ensure safe discharge planning for all patients, including geriatric patients in various hospital settings.
  • Perform any other related duties as assigned.

Requirements:

  • Minimum 2 years of experience as a Registered Nurse required; 3 years of clinical ED, critical care, or med/surg experience preferred.
  • NYS RN license required.
  • Certifications: BLS, COVID Vaccine Required.
  • Must-Have: Discharge experience, COVID Vaccine, PRI Certification (to be obtained within 3 months of initial employment), and Strong preference for screen certification.
  • Preferred: Care Management certification, experience with Milliman/InterQual criteria, strong computer skills, knowledge of healthcare financial, regulatory, and payer issues, and familiarity with state, local, and federal programs.

Charting System:
Epic.

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