RN Case Manager – Utilization Review - 239239 New

About the Role - RN Care Manager (interqual experience + BSN required)

Hours: 5 days a week in person M-F 8-5 OR if someone wants to do 4 10 hour shifts M-TH. (could include working weekends occasionally, must be flexible)

Pay: $45-46/hr

Responsibilities:

• The RN Care Manager assesses, develops, implements, coordinates and monitors a comprehensive plan of care for each patient/family in collaboration with the physician, social worker, nurse and all members of the interdisciplinary team for the inpatient, Emergency Department and all patient care areas.
• This position requires the ability to combine clinical/quality considerations with regulatory/financial/utilization review demands to assure patients are receiving care in the appropriate setting and level of care.
• The Care Manager must understand insurance and payment system regulations and requirements as they serve as a resource to third party providers.

Qualifications:

• Minimum of 4 years recent acute Medical Surgical, Psychiatric, ED nursing or prior case management experience.
• Current N.Y.S. licensed Registered Nurse with BSN. ACM or CCM highly preferred
• Patient Review Instrument (PRI) certification is highly preferred
• Knowledge of payer eligibility and reimbursement regulations and the impact on the continuum of care.
• Knowledge of screening criteria i.e. InterQUAL, MCG criteria.
• Knowledge of discharge planning regulations and community resources to coordinate safe discharges from the inpatient units and the ED to outpatient settings.
• Excellent negotiation and interpersonal/communication skills and the ability to work effectively with others on the team to achieve desired outcomes.
• Organizational time management skills as evidenced by capacity to multitask and prioritize work.
• Ability to work in a collaborative partnership model with Social Workers and other members of the interdisciplinary team both internal and external.