ED RN Case Manager | Evening

Stony Brook University • Stony Brook, NY

8d • Onsite

About The Position

At Stony Brook Medicine, the TH Staff Associate/RN Case Manager in the Emergency Department is a member of the interdisciplinary care team who provides clinical case management, utilization management, and care coordination for patients presenting to the Emergency Department. The RN Case Manager works with physicians, nursing, Social Work, Care Management, hospital leadership, and other healthcare team members to determine the appropriate level and setting of care, facilitate timely patient progression, and identify opportunities for safe discharge or transition from the Emergency Department.

Using clinical judgment, MCG criteria, payer requirements, and applicable regulatory guidelines, the RN Case Manager evaluates medical necessity and level of care for inpatient, observation, emergency, and outpatient services. The role also identifies complex discharge needs and barriers to care, coordinates appropriate resources and follow-up, supports safe transitions, and promotes efficient patient flow while helping reduce avoidable admissions and readmissions.

This position requires weekend and holiday coverage. The role may be designated essential during an institutional emergency and may require wearing respiratory protection. Hospital positions may be subject to changes in pass days and shifts as necessary.

Requirements

• Current New York State Registered Professional Nurse license.
• Bachelor's degree in Nursing or a related field.
• At least five years of clinical nursing experience.
• Strong clinical assessment and critical-thinking skills, including the ability to evaluate complex patient presentations and determine appropriate level of care.
• Computer proficiency, including Microsoft Office Suite and electronic medical record systems.
• Excellent communication, interpersonal, organizational, and collaboration skills.
• Ability to work effectively with physicians, patients, families, and interdisciplinary healthcare teams.
• Strong customer-service skills.
• Ability to prioritize and manage multiple time-sensitive responsibilities in a fast-paced Emergency Department environment.
• Creative, flexible, professional, and courteous demeanor.
• Availability for weekend and holiday coverage.

Nice To Haves

• Case Management and/or Utilization Management certification.
• Five years of Case Management and/or Utilization Management experience.
• Working knowledge of MCG (Milliman Care Guidelines) and/or InterQual criteria.
• Recent clinical, Case Management, or Utilization Management experience in an Emergency Department and/or tertiary care hospital.
• Experience performing medical-necessity and level-of-care determinations.
• Experience with discharge planning, transitions of care, and coordination of post-acute and community-based services.
• Knowledge of payer authorization and regulatory requirements.
• Master's degree.
• Management or supervisory experience.
• PRI certification.
• Bilingual ability.

Responsibilities

• Screen Emergency Department patients to determine medical necessity and the appropriate level and setting of care, including inpatient admission, observation, continued emergency care, or discharge with services and follow-up.
• Apply MCG criteria alongside clinical judgment, physician documentation, payer requirements, and regulatory guidelines to support level-of-care determinations.
• Collaborate with Emergency Department physicians and the interdisciplinary team on patient status, medical necessity, and disposition; identify cases requiring additional review or escalation.
• Perform initial utilization review and assist with payer notification, authorization, and clinical documentation requirements for hospitalization or observation.
• Identify patients who may be treated safely in a lower or alternative level of care and coordinate appropriate disposition.
• Assess patients in a timely manner to identify high-risk patients and complex medical, functional, psychosocial, financial, or discharge-planning needs.
• Coordinate Emergency Department discharge planning, including home care, durable medical equipment, rehabilitation, skilled nursing placement, transportation, community services, outpatient follow-up, and other appropriate resources.
• Identify barriers to safe discharge and work with physicians, Social Work, nursing, patients, families, and community providers to develop transition plans.
• Identify patients with frequent Emergency Department utilization, recent hospitalizations, or other increased-risk indicators and collaborate on strategies to address needs and promote continuity of care.
• Communicate with patients and families about the plan of care, discharge needs, available resources, and transition planning.
• Promote efficient patient flow by identifying and addressing barriers to disposition and facilitating timely transitions to appropriate care settings.
• Collaborate with inpatient Case Management when patients require admission to support continuity of care and effective transition from the Emergency Department.
• Maintain accurate and timely documentation of utilization review, level-of-care determinations, assessments, interventions, discharge planning, and disposition.
• Review data to identify trends, barriers, and opportunities to support appropriate utilization, improved patient flow, fewer avoidable admissions and readmissions, and high-quality care.
• Maintain knowledge of CMS requirements, payer policies, regulatory standards, community resources, and Case Management/Utilization Management practices.
• Support a safe, efficient, patient-centered environment that promotes patient and physician satisfaction, timely patient flow, and high-quality customer service.
• Perform other duties as assigned.

Benefits

• Comprehensive benefits, including generous leave, health insurance, and participation in the state pension system.
• Some positions may include annual supplemental pay such as location pay for UUP, CSEA, and PEF full-time positions, and shift differentials for evening, night, or other supplemental shifts.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level