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Case Manager
2 months ago
Montefiore Medical Center is seeking a skilled RN Case Manager to coordinate the continuum of medical care services for patients. This role requires strong analytical and problem-solving skills, as well as excellent communication and interpersonal skills.
Key Responsibilities- Coordinate patient care services to ensure optimum utilization of resources and delivery of quality care
- 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
- Develop and implement effective care plans to meet patient needs and improve outcomes
- Collaborate with healthcare teams to ensure seamless care transitions and optimal patient outcomes
- Stay up-to-date with regulatory, accrediting, and contractual requirements to ensure compliance
- 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 and case management preferred
- Certification in Utilization Review or Case Management preferred
- Experience in a managed care organization preferred
- Excellent analytical, problem-solving, 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
Montefiore Medical Center offers a competitive salary and benefits package, as well as opportunities for professional growth and development.