Clinical Case Manager

2 weeks ago


Sleepy Hollow, California, United States Northwell Health Full time
Job Summary

We are seeking a skilled Registered Nurse to join our team as a Case Manager. The successful candidate will be responsible for coordinating patient care, ensuring a continuum of quality care, and overseeing provisions for patient discharge.

Key Responsibilities
  • Facilitate patient management throughout hospitalization, ensuring a smooth transition of care.
  • Perform concurrent utilization management using evidence-based medical necessity criteria to optimize patient outcomes.
  • Submit data to management regarding case management and quality initiatives to drive improvement.
  • Serve as an in-patient liaison, planning, assessing, implementing, and evaluating patient care in collaboration with the healthcare team.
  • Conduct chart reviews to ensure 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 the patient, family, admitting, primary care physician, healthcare team, and hospital departments.
Requirements
  • Graduate from an accredited School of Nursing. Bachelor's Degree in Nursing, preferred.
  • Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed.
  • Minimum 1 year RN Case Management experience required.

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