Nurse, Care Management - Full-Time, Days 3 Years of Clinical RN Acute Care Experience REQUIRED

NYU Langone Health • Mineola, NY

5h • $147,154 - $180,190

About The Position

NYU Langone Hospital—Long Island is a 591-bed university-affiliated medical center providing diagnostic and therapeutic care across a broad range of medical and surgical specialties, as well as inpatient and outpatient services. The organization emphasizes medical education, research, equity, and inclusion.

The Nurse, Care Management coordinates and procures services for patients who need post-acute care, supporting timely transitions to appropriate care settings. The nurse collaborates with internal and external interdisciplinary teams, participates in quality improvement and patient-care evaluation, and completes timely, accurate insurance reviews to support provider reimbursement.

This is a full-time, day-shift position. The salary range is $147,153.96–$180,190.08 annually. Actual compensation depends on factors including experience, specialty, education, and hospital need; the stated range excludes bonuses, incentive pay, differentials, and other compensation or benefits.

Requirements

• Bachelor's degree in Nursing required for employees hired after September 1, 2020; employees hired before that date are grandfathered.
• Current and valid New York State Registered Nurse license.
• BLS certification issued by the American Heart Association.
• 3–5 years of clinical acute-care experience.
• Excellent oral and written communication, interpersonal, and organizational skills.
• Knowledge of clinical standards of practice for multiple patient populations.
• Computer skills.
• Ability to communicate effectively with all levels of the organization.

Nice To Haves

• New York State Department of Health Patient Review Instrument (PRI) Assessor qualification.
• 3–5 years of discharge-planning and/or utilization-management experience.
• Knowledge of post-acute care referral processes for procuring patient services.
• Knowledge of hospital reimbursement processes, insurance denials, and appeals.

Responsibilities

• Perform initial utilization reviews for appropriateness of patient setting using standard clinical criteria, such as InterQual and Milliman Care Guidelines; collaborate with the attending physician and Physician Advisor when a patient does not meet the criteria for the ordered level of care.
• Conduct continued-stay and extended-stay reviews when acuity changes, authorized days expire, payer contracts require review, or a stay is denied or reduced to a lower level of care.
• Submit timely clinical reviews to payers to obtain certification of patient days and secure reimbursement; work with the attending physician, Physician Advisor, and multidisciplinary team to address concurrent denials.
• Screen inpatients for potential post-acute care needs, assess discharge needs for qualifying or referred patients, and develop discharge plans with patients or designees and the care team that incorporate patient preferences.
• Implement discharge plans by referring patients to appropriate post-acute services and providing necessary medical information; review readmissions to assess whether discharge planning addressed patient needs.
• Complete required documentation using Allscripts and prepare the Patient Review Instrument (PRI) accurately and promptly.
• Identify and report risk and quality issues, and track avoidable days in Allscripts to identify improvement opportunities.
• Provide required patient notices under CMS participation requirements, payer contracts, and hospital policy, including applicable IM, Discharge Notice, ABN, Detailed Notice of non-coverage, Preadmission/Admission Notice of non-coverage, and HINN notices.
• Process Medicare Code 44 when appropriate and explain billing status to the patient or designee when Code 44 or observation is ordered.
• Participate in interdisciplinary patient-care unit meetings to review clinical status, care plans, discharge plans, and expected discharge dates; facilitate communication among team members.
• Coordinate patient-care conferences with appropriate team members and the patient or designee to identify barriers and concerns, resolve conflicts, and communicate care-plan choices.
• Participate in scheduled in-service activities and continuing education programs.
• Perform other duties as assigned.

Benefits

• Comprehensive benefits and wellness package.
• Financial security benefits.
• Generous time-off program.
• Employee resource groups for peer support.
• Employee wellness program covering physical, mental, nutritional, sleep, social, financial, and preventive-care well-being.
• Resources and services intended to support employees and their families at different life stages.

What This Job Offers

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