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Case Manager

2 months ago


Fort Lee, New Jersey, United States Montefiore Medical Center Full time
Job Summary

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
Requirements
  • 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
Preferred Qualifications
  • 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
What We Offer

Montefiore Medical Center offers a competitive salary and benefits package, as well as opportunities for professional growth and development.