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Case Manager – RN – Days
| Company | NewYork-Presbyterian |
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| Location | Brooklyn, NY, USA |
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| Salary | $112508 – $149911 |
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| Type | Full-Time |
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| Degrees | Bachelor’s |
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| Experience Level | Mid Level, Senior |
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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
Responsibilities
- Responsible for all aspects of discharge planning and utilization management/review for an assigned group of patients
- Assist in the development of the plan of care; ensure that the plan is implemented timely and identify the expected length of stay (ELOS)
- 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
Preferred Qualifications
- Master’s degree
- CCM certification
