RN Care Manager

Clinical Coordinator, Nursing

Position Summary

The Clinical Coordinator / 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

• Understands and adheres to the WPH Performance Standards, Policies, and Behaviors.

• Completes a comprehensive initial assessment.

• Performs all activities for multidisciplinary care coordination at the intra-hospital level of care and inter-hospital level of care.

• Performs all transitional planning activities including, but not limited to:

  • Patient/caregiver education

  • Arrangement of all aftercare

  • Commercial payer involvement

  • High utilizer patient root cause

• Communicates and collaborates all relevant patient information to appropriate health team members.

• Ensures department goals of LOS reduction, readmission prevention, denial reduction, and satisfaction improvement are realized.

• Documents per department requirements.

• Participates in Performance Improvement activities as needed.

• Performs all UR activities per department policy:

  • Commercial payer reviews

  • Disposition determination

  • Retro/self-audit

  • MC variance

  • Admission clinical review

• 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.

• Performs all other related duties as assigned.

Education & Experience Requirements

• BSN required

• Licensure: Registered Nurse (RN) NYS license required.

• Certifications:

  • PRI Certification (must be obtained within 3 months of initial employment).

  • Screen certification (strongly preferred).

  • Care Management certification (e.g., CMC, CCM, etc.) preferred.

• Clinical Experience: 3 years clinical ED, critical care, or med/surg experience preferred.

• Case Management: Previous case management experience preferred.

• Technical Knowledge: * Knowledge of healthcare financial, regulatory, and payer issues preferred.

  • Knowledge of state, local, and federal programs strongly preferred.

  • Experience in use of Milliman/InterQual criteria.

• General Skills: Essential computer skills.

 If you're interested, please reply to this advertisement or directly email your resume to me at DSalgado@teemagroup.com or by calling/texting (949) 295-5951.

I strive to reply within 48 hours. Looking forward to connecting with you soon. Thank you!