RN Care Manager

RN Care ManagerWhite Plains, NY NursingFull TimeDepartmentLocation: Care ManagementDay: M-F 9A-5P with a weekend rotation ( Sat & Sun)Position Summary 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 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: 1. Understands and adheres to the WPH Performance Standards, Policies and Behaviors2. Completes a comprehensive initial assessment.3. Performs all activities for multidisciplinary care coordination at the intra-hospital level of care and inter-hospital level of care.4. Performs all transitional planning activities including but not limited to:•Patientcaregiver education•rrangement of all aftercare•Commercial payer involvement•High utilizer patient root cause5. Communicates and collaborates all relevant patient information to appropriate health team members.6. Ensures department goals of LOS reduction, readmission prevention, denial reduction, and satisfaction improvement are realized.7. Documents per department requirements.8. Participates in Performance Improvement activities as needed.9. Performs all UR activities per department policy:•Commercial payer reviews•Disposition determination,•Retroself-audit•MC variance•dmission clinical review.10. The RN Care Manager collaborates with all Health Care professionals to evaluate the needs and the safe discharge of all geriatric patients including but not limited to inpatients, emergency department and surgical outpatients.11. Performs all other related duties as assignedEducation & Experience Requirements •BSN required for all RNs hired after 1118•ll RNs hired before 1118 will be required to have their BSN (or MSN) by 123121.•Registered Nurse (RN) NYS license required•PRI Certification (PRI certification to be obtained within 3 months of initial employment)•Screen certification strongly preferred•Care Management certification preferred (i.e. CMC, CCM etc.)•3 years clinical ED, critical care or medsurg experience preferred•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 MillimanInterQual criteria A Care Management certification preferred (i.e. CMC, CCM etc.)Computer skills essentialCore 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.

Created: 2025-02-17