Case Manager RN - Inpatient Units - Brooklyn Methodist - Days

NewYork-Presbyterian Hospital

23d • Onsite

About The Position

Case Manager - RN - Inpatient Units- Brooklyn Methodist - Days Located in Park Slope, Brooklyn, this acute-care teaching hospital has been providing outstanding medical care to the surrounding communities for over 135 years. The Case Manager is responsible for all aspects of discharge planning and utilization management/review for an assigned group of patients to determine the appropriateness of the admission and continued stay, assist in the development of the plan of care; ensure that the plan is implemented timely and identify the expected length of stay (ELOS). The Case Manager works collaboratively with physicians, social workers, clinical nurses, home care services, and other members of the interdisciplinary team. The Case Manager actively participates in specific clinical initiatives focused on reducing the length of stay (LOS), improving efficiency and quality, and ensuring resource utilization is appropriate. Case manager/utilization manager: Responsible for an average of 60-70 medical/surgical daily admissions that requires risk identification and clinical reviews. A utilization nurse completes no less than 20 initial clinical reviews daily. This is a full time Monday – Friday position 8:30am -5:00pm Position requires weekend rotation and holidays.

Requirements

• Current NYS RN license
• Bachelor’s degree in Nursing (BSN)
• 3-5 yrs Acute Care RN nursing experience
• Previous experience in inpatient acute care case manager/discharge planning, certified home health care (CHHA), Case Management experience, utilization experience, or managed care organization experience required
• PRI certification
• BCLS Certification

Nice To Haves

• Master’s degree
• CCM certification

Responsibilities

• Completing 100% clinical reviews for managed care, Medicare and Medicaid admissions
• Completing concurrent and retrospective reviews
• Communicating with physicians and the inpatient case management teams on patients who do not meet initial inpatient criteria or continued inpatient stay
• Coordinating expedited appeals for inpatient denials with attending physicians and insurance providers
• Ensuring organization resources are being utilized appropriately
• Completing patient assessments within 24 hours
• Coordinating safe and appropriate post-acute care plans
• Obtains authorizations from managed care companies for post-discharge services.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees