Nurse Case Manager RN
1 week ago
HealthCare Partners, IPA is seeking a skilled Nurse Case Manager, RN to join our team. As a key member of our healthcare delivery system, you will play a critical role in ensuring the delivery of high-quality care to our members.
Job Summary:The Nurse Case Manager, RN is responsible for coordinating and overseeing the care management and discharge planning for patients within a designated region or assigned group. This role requires strong clinical judgment, effective communication skills, and the ability to work collaboratively with interdisciplinary teams to achieve optimal care outcomes.
Key Responsibilities:- Conduct medical necessity reviews for inpatient admissions using evidence-based criteria to confirm appropriateness of care.
- Perform concurrent reviews to assess the need for continued hospitalization, ensuring extended stays are medically justified and properly documented.
- Collaborate with attending physicians, care managers, and the interdisciplinary team to develop and support timely discharge plans, ensuring care is delivered within the expected length of stay for specific medical conditions.
- Apply consistent use of MCG guidelines to verify medical necessity for admission and continued hospitalization.
- Identify anticipated discharge dates and work with the interdisciplinary team to coordinate appropriate post-hospital care, including necessary follow-up services.
- Utilize clinical judgment to assess underlying causes of hospitalization, implementing strategies to reduce the likelihood of readmission.
- Ensure adherence to evidence-based criteria, clinical guidelines, and standardized care management protocols while maintaining compliance with regulatory standards and addressing patient needs.
- Active RN license in New York State (NYS) required.
- Bachelor of Science in Nursing (BSN) preferred.
- A minimum of 3-5 years of experience in a healthcare setting, preferably in an acute care environment.
- Prior experience in utilization management (UM) and case management/care coordination.
- Experience in educating patients and families on care plans and discharge procedures.
HealthCare Partners, IPA offers a competitive salary range of $90,000 - $105,000, as well as a bonus incentive of up to 5% of base salary. We are an equal employment opportunity employer and comply with applicable state and local laws governing nondiscrimination in employment.
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