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Nurse Case Manager
2 months ago
Serves as a key liaison between patients and healthcare facilities/physicians, ensuring a seamless continuum of quality patient care throughout hospitalization. Oversees provisions for patient discharge and assesses, plans, and evaluates the appropriateness of care throughout admission and hospitalization.
Key Responsibilities- Facilitates patient management throughout hospitalization, ensuring timely and effective care.
- Conducts concurrent utilization management using evidence-based medical necessity criteria to optimize patient outcomes.
- Submits data to management regarding case management and quality initiatives to drive improvement.
- Serves as an in-patient liaison, planning, assessing, implementing, and evaluating patient care in collaboration with the healthcare team.
- Conducts chart reviews to ensure appropriateness of admission and continued length of stay, facilitating efficient throughput.
- Interacts with third-party payers to obtain approval of hospital days, pre-certification, and post-discharge eligibility in relation to clinical course.
- Ensures compliance with current state, federal, and third-party payer regulations.
- Documents the case management process in the medical record and completes a care coordination assessment on the patient.
- Serves as a liaison to patients, families, admitting, primary care physicians, healthcare teams, and hospital departments.
- Completes applicable areas of the patient's discharge instruction sheet and patient transfer sheet, ensuring case management documentation is current and accurate.
- Graduate from an accredited School of Nursing; Bachelor's Degree in Nursing preferred.
- At least 5 years of acute care nursing experience.
- Prior Case Management and/or Utilization Review experience.
- BLS certification.
- PRI certification preferred.
- Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed.
