Case Manager RN
4 weeks ago
The RN Care Manager performs the initial comprehensive assessment on admission in accordance with the Care Management Department policy, screening all patients by utilizing established tools for high risk indicators (i.e. AIMS, Geisinger, polypharmacy) to ensure high risk patient populations receive the appropriate supportive services for discharge to prevent readmission and assess all populations for potential discharge planning needs. Provides ongoing reassessment of needs throughout the hospital course. Performs UR activity per department policy.
Essential Functions and Responsibilities Includes the Following:
Understands and adheres to the WPH Performance Standards, Policies and Behaviors
Completes a comprehensive initial assessment.
Performs all activities for multidisciplinary care coordination at the intra-hospital level of care and inter-hospital level of care.
Performs all transitional planning activities including but not limited to:
Patient/caregiver education
Arrangement of all aftercare
Commercial payer involvement
High utilizer patient root cause
Communicates and collaborates all relevant patient information to appropriate health team members.
Ensures department goals of LOS reduction, readmission prevention, denial reduction, and satisfaction improvement are realized.
Documents per department requirements.
Participates in Performance Improvement activities as needed.
Performs all UR activities per department policy:
Commercial payer reviews
Disposition determination,
Retro/self-audit
MC variance
Admission clinical review.
Performs all other related duties as assigned
Education & Experience Requirements
BSN or related Bachelor's degree required
5 years clinical ED, critical care or med/surg experience required
Previous case management experience preferred
Knowledge of healthcare financial, regulatory, and payer issues preferred
Knowledge of state, local, and federal programs strongly preferred
Experience in use of Milliman/InterQual criteria
Registered Nurse (RN) NYS license required
PRI/Screen certification strongly preferred.
C.C.M. (Certified Case Manager) certification preferred
Computer skills essential
Core Competencies
Demonstrates ability to establish two-way communication by clearly defining expectations, communicating utilizing a variety of methods, actively listening to ideas and concerns and responding in an appropriate manner.
Demonstrates ability to delegate responsibilities appropriately.
Demonstrates ability to retain composure under stress and perform multitasking functions.
Physical/Mental Demands/Requirements & Work Environment
May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital’s SDS (Safety Data Sheet) data base and may be accessed through the hospital’s Intranet site (Employee Tools/SDS Access). A copy of the SDS data base can also be found at the hospital switchboard, saved on a disc.
Must be physically able to walk, stand and/or sit for extended periods of time, with the ability to carry necessary equipment (i.e., IPad or laptop) on rounds. Must be able to perform difficult manipulative, arm-hand steadiness and hand-eye coordination skills. Must be able to meet all regulatory requirements. Demonstrates ability to follow written and oral instructions required for the position.
Demonstrates ability to analyze multidimensional problems into component parts and sort out tasks in priority order to solve the problem.
Must be able to see object closely and far away, hear normal sounds with some background noise. Communicates effectively verbally and in writing.
Primary Population Served
Check appropriate box(s) below:
Neonatal (birth – 28 days)
Patients with exceptional communication needs
Infant (29 days – less than 1 year)
Patients with developmental delays
Pediatric (1 – 12 years)
Patients at end of life
Adolescent (13 – 17 years)
Patients under isolation precautions
Adult (18 – 64 years)
Patients with cultural needs
Geriatric (> 65 years)
All populations
Bariatric Patients with weight related comorbidities
Non-patient care population
The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of White Plains Hospital.
Location: White Plains Hospital · Care Management
Schedule: Full Time, Day, Mon-Fri, 8:30a-4:30p or 9a-5p; monthly weekend rotation(Saturday & Sunday)
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