RN Case Manager

Job Description - RN Case Manager (2503755)

RN Case Manager

Position Summary

At Stony Brook Medicine, a RN Case Manager is a valuable member of our team, who provides clinical services to our patient population. Qualified candidates will demonstrate superior patient care and possess outstanding communication skills while adhering to our high standard of excellence.

Duties of a RN Case Manager in the Care Management Department may include the following but are not limited to:

• Completes Utilization review screen for inpatient and observation cases. Activity includes UR from the Emergency Room or on the unit to ensure guidelines are reviewed and the plan of care is discussed with the team. Works closely with the Case Managers and Social Workers on the units and reviews findings with them. Ensures that patients are placed in the correct level of care from initial assess point.
  
  Follows cases for authorization for in patient stay.
• Staff review short stay, long stay and complex cases to affect and ensure a safe discharge plan. Completes retrospective review, one and two day short stay reviews and other projects as assigned. Identifies, follows and documents Avoidable delays in Care Management Program. Reviews and documents on patients who were readmitted within thirty days. Documents over utilization of resources and services.
• All Medicare cases are reviewed for level of care on admission. Reviews with the Attending, any patient who does not meet in-patient criteria for admission. Follows the process for Code 44 on Medicare patients. Follow the process for Code 44 on all other payers.
• Active participation with the physician and payer to prevent denials. Reviews cases for potential change in level of care with the CM and physician.
• Communicates with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals.
• Consistent documentation in the EMR regarding acuity, plan of care and communication with the team. Charting includes data for authorization and data management.
• Reviews cases daily from admission through discharge to prevent denials.
  
  This includes patient and family contacts, insurance authorizations, tests, procedures, community resources etc.
• Assistants with coordination for discharge planning including patient and family education with the interdisciplinary team. Coordinates transitional care planning for outpatient resources, prepares PRI for early referrals and contacts with agencies and facilities throughout the hospital stay.
• Actively involved in performance improvement activities including program development, data collection and analysis.
• Maintain high level customer service.
• All unit coverage as needed and other duties as required.

Qualifications

Required
: A Bachelor’s degree or a nurse working on their degree with an RN license and working history of 5 years in hospital setting. A candidate should have a good understanding of the admission/discharge process. They need good interpersonal skills to work with all team members. They need to document accurately and be able to prioritize their work and follow up with cases.

Preferred: CM, UM, Quality, Coding, Risk or MCG Certification Working knowledge of MCG or Interqual

PRI Certified Knowledge of regulatory requirements

Bilingual

Recent experience in tertiary care Experience in pediatrics, NICU, Mother/Baby or ED Leadership skills

Master’s prepared.

Please Note: Verification of degree (e.g., diploma or official transcript) is required for this role. Upload of documentation must be included with your application for consideration.

Special Notes
: Resume/CV should be included with the online application.

Posting Overview
: This position will remain posted until filled or for a maximum of 90 days.

An initial review of all applicants will occur two weeks from the posting date. Candidates are advised on the application that for full consideration, applications must be received before the initial review date (which is within two weeks of the posting date).

If within the initial review no candidate was selected to fill the position posted, additional applications will be considered for the posted position;…