Nurse Case Manager
1 month ago
Vassar Brothers Medical Center is seeking a skilled Nurse Case Manager to join our team. As a key member of our care coordination team, you will play a vital role in ensuring the delivery of effective and efficient patient care.
Job Summary:The Nurse Case Manager will provide clinically-based case management to support the delivery of effective and efficient patient care. This includes pacing the case from physiological and economic perspectives, utilizing criteria to confirm medical necessity for admission and continued stay, and creating a discharge plan appropriate to the patient's needs and resources.
Key Responsibilities:- Determine medical necessity, appropriateness of admission, continuing stay, and level of care using a combination of clinical information, clinical criteria, and third-party information.
- Validate admission and continuing stay criteria with third-party payers and primary care and attending physicians.
- Collaborate with the third-party payers to anticipate denial of payment and proactively address issues contributing to a potential denial.
- Support the effective prevention and management of denials, including providing information as part of the appeal process.
- Assess the patient and family for continuing care needs to develop, implement, and evaluate an effective discharge plan in collaboration with the multidisciplinary team.
- Collaborate and communicate with patients/families related to reimbursement issues and to create a discharge plan.
- Provide support and counseling to patients/families experiencing and/or anticipating issues to adjusting to illness, catastrophic diagnoses, changes in living situations, and bereavement.
- Minimum 3 years of experience in acute care.
- Associate's Degree or BSN preferred.
- Current RN license.
- Preferred experience in Utilization Review/Management.
Vassar Brothers Medical Center offers a competitive salary and benefits package, as well as opportunities for professional growth and development.
We are an equal opportunity employer and welcome applications from diverse candidates.
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