RN Case Manager

3 days ago


Forest Hills, New York, United States Northwell Health Full time
Job Summary

We are seeking a skilled Registered Nurse Case Manager to join our team at Northwell Health. As a key member of our healthcare team, you will serve as a liaison between patients and healthcare providers, ensuring a continuum of quality patient care throughout hospitalization.

Responsibilities
  • Facilitate patient management throughout hospitalization, ensuring seamless transitions and effective care coordination.
  • Perform concurrent utilization management using evidence-based medical necessity criteria to optimize patient outcomes.
  • Submit data to management regarding case management and quality initiatives, driving continuous improvement.
  • Serve as an in-patient liaison, collaborating with the healthcare team to plan, assess, implement, and evaluate patient care.
  • Conduct chart reviews to ensure appropriateness of admission and continued length of stay, facilitating throughput and efficient care delivery.
  • Interact with third-party payers to obtain approval of hospital days, pre-certification, and post-discharge eligibility, ensuring compliance with regulatory requirements.
  • Ensure compliance with current state, federal, and third-party payer regulations, maintaining accurate and up-to-date documentation.
  • Document the case management process in the medical record, completing and documenting a care coordination assessment on the patient.
  • Serve as a liaison to patients, families, admitting, primary care physicians, healthcare teams, and hospital departments, fostering effective communication and collaboration.
  • Complete applicable areas of the patient's discharge instruction sheet and patient transfer sheet, ensuring case management documentation is current and accurate.
Qualifications
  • Graduate from an accredited School of Nursing.
  • Bachelor's Degree in Nursing, preferred. Must be enrolled in an accredited BSN program within two years and obtain a BSN Degree within five years of job entry date.
  • Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed.


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