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Clinical Case Manager
2 months ago
Montefiore Medical Center is seeking a skilled Clinical Case Manager to join our team. As a key member of our Utilization Management department, you will play a critical role in ensuring the optimal utilization of resources and delivery of quality patient care.
Responsibilities:- Coordinate the continuum of medical care services for patients to ensure compliance with regulatory, accrediting, and contractual requirements.
- Determine the appropriateness of patient care services and prepare clinical appeals for third-party denials.
- Collect and interpret data for utilization, compliance, quality improvement, and other areas as assigned.
- BSN or a bachelor's degree in a related field required; Master's preferred.
- NYS RN License required.
- PRI assessor number required prior to end of 3-month probationary period.
- 3-5 years recent acute care clinical experience preferred.
- Experience in utilization management preferred.
- Experience in a managed care organization preferred.
- Certification in Utilization Review or Case Management preferred.
- Analytical skills, problem-solving skills, conflict resolution, and negotiation skills.
- Demonstrated knowledge of federal, state, and commercial/third-party regulations related to utilization management functions, discharge planning, and associated processes.
- Demonstrated knowledge of quality/performance improvement tools and techniques.
- Demonstrated knowledge of utilization and case management principles.
- Experience in the application of utilization management decision support criteria preferred.
- Computer skills including data entry, word processing, and electronic messaging.
- Experience in the use of Windows-based software applications.
- Experience in the use of an electronic clinical information system preferred.
- Excellent verbal, written, and interpersonal communication skills, as well as a commitment to interdisciplinary teamwork.
- Excellent organization skills, teamwork skills, and time management skills.
- Expert clinical knowledge of disease processes to identify care needs.
- Understanding of the healthcare delivery system and its sites of care, delivery models, and the roles of various providers and healthcare professionals.
- Experience in interpreting and applying benefit coverage rules and assessing coordination of benefits guidelines and managed care regulations required.
Department: Utilization Management Bargaining Unit: 1199 RN Campus: WAKEFIELD Employment Status: Regular Full-Time Address: 600 East 233rd Street, BronxShift: Day Scheduled Hours: 9 AM-5 PM Req ID: 220528 Salary Range/Pay Rate: $61.68
Montefiore Medical Center is an equal employment opportunity employer. We are committed to recruiting and creating an environment in which associates feel empowered to thrive and be their authentic selves through our inclusive culture.
