RN - CM - UM - Case Manager - New York, NY

Company: Tandym Group
Location: New York
Posted on: September 19, 2023

Job Description:

A New York City-based health services organization is currently seeking an experienced, licensed Registered Nurse (RN) to join their staff as their new Case Manager. In this role, the Case Manager (RN) will be responsible for all aspects of case management for an assigned group of inpatients to determine the appropriateness of the admission and continued stay, assist in the development of the plan of care.
Responsibilities:
The Case Manager (RN) will be responsible for:

• Review all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve optimal patient outcomes and appropriate reimbursement for the organization
• Perform continued stay reviews utilizing standardized criteria to justify continued inpatient stay
• Assess patient's clinical, psychosocial, and functional status in collaboration with the interdisciplinary team
• Identify and document variances affecting the LOS and the discharge planning process
• Conduct follow-up of any delays in treatment or reporting of results
• Plan and develop specific goals with the Physician, interdisciplinary team, and the patient and/or family
• Document outcomes achieved and identified internal and external barriers
• Appropriately identify and refer cases to the Physician Advisor to support timely progression of patients along the continuum of care and (appropriate) discharge planning
• Interact with patient/family to discuss plan of care and coordination of services based on clinical needs and available resources
• Provide the clinical information requested by the managed care companies as part of the concurrent review in a timely fashion
• Provide clinical information requested by the managed care companies in accordance with contractual agreements
• Obtain authorizations from managed care companies for post-discharge services
• Perform other duties, as needed Qualifications:
  • 3+ years of Nursing experience in an Acute Care setting
  • Associate's and/or Bachelor's Degree in Nursing
  • Current NYS Registered Nurse (RN) license
  • ACLS, BLS and PALS certifications
  • PRI Certification (to be obtained within 1 year) Desired Skills:
    • CCM certification
    • Experience as a Discharge Planner or Case Manager
    • Previous experience in a Home Care, Long Term Care, and/or Utilization Review

Keywords: Tandym Group, New York , RN - CM - UM - Case Manager - New York, NY, Executive , New York, New York