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

NYU Langone Health • Mineola, NY

18h

About The Position

NYU Langone Hospital—Long Island is a 591-bed university-affiliated medical center offering diagnostic and therapeutic care across specialties and subspecialties, along with inpatient and outpatient services. The hospital is committed to medical education, research, equity, and inclusion.

The Nurse, Care Management coordinates services for patients who need post-acute care, supporting a timely transition to the most appropriate setting. The nurse works with interdisciplinary care teams inside and outside the organization, contributes to quality improvement and patient care evaluation, and supports provider reimbursement through timely and accurate insurance reviews.

Requirements

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

Nice To Haves

• Bachelor's degree in Nursing.
• New York State Department of Health Patient Review Instrument (PRI) Assessor qualification.
• Three to five 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 to assess whether patients meet criteria for their level of care, using industry-standard criteria such as InterQual and Milliman Care Guidelines.
• Collaborate with the attending physician and Physician Advisor when a patient does not meet criteria for the ordered level of care.
• Perform 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 physicians and the multidisciplinary team to mediate concurrent denials.
• Screen inpatients for potential post-acute care needs and assess discharge needs for patients who meet screening criteria, are referred by the care team, or are requested by the patient or designee.
• Develop discharge plans with the patient or designee and care team, incorporating patient preferences.
• Implement discharge plans by referring patients to appropriate post-acute care services and supplying necessary medical information.
• Review readmissions to assess whether discharge plans met patients' needs.
• Complete departmental documentation and Patient Review Instruments (PRI) accurately and promptly, using Allscripts.
• Identify and report risk and quality issues to the appropriate department.
• Track avoidable days in Allscripts to identify improvement opportunities.
• Provide required patient notices under CMS conditions of participation, payer contracts, and hospital policy, including applicable discharge and non-coverage 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 meetings to review clinical status, plans of care, discharge plans, and expected discharge dates.
• Facilitate communication among interdisciplinary healthcare 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.
• Holistic employee wellness program covering physical, mental, nutritional, sleep, social, financial, and preventive-care well-being.

What This Job Offers

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