Case Management RN | Discharge & Utilization Specialist

Mount Sinai; United States; On-site; USD 75,000 - 107,000; Full time

Job summary

Mount Sinai Health System seeks an RN Case Manager to oversee case management for a defined patient group, coordinating LOS, care plans, and discharge planning with an interdisciplinary team. The role emphasizes utilization review, documentation, and collaboration with physicians and managed care to optimize outcomes and reimbursement.

Requirements include a NYS RN license, a BSN (MSN preferred), and CCM/PRI/BLS certifications as applicable; 3-5 years of acute care RN experience with home care

Qualifications

• Bachelor’s degree in nursing is required with a master’s preferred.
• Active NYS Registered Nurse license is mandatory.
• CCM certification preferred; re-credentialing expected.
• PRI certification to be obtained within 1 year.

Responsibilities

• Assess clinical, psychosocial, and functional status with the interdisciplinary team.
• Coordinate discharge planning and obtain post-discharge authorizations.
• Collaborate with physicians and managed care for utilization review and appeals.
• Document outcomes and track barriers to care and readmissions.

Skills

RN experience 3-5 years

Discharge planning experience

Utilization review experience

Home care / long term care experience

Education

Bachelors Degree in Nursing; Masters preferred

NYS RN license

CCM certification

PRI Certification

BLS (Basic Life Support)

Job description

Mount Sinai Health System seeks an RN Case Manager to oversee case management for a defined patient group, coordinating LOS, care plans, and discharge planning with an interdisciplinary team. The role emphasizes utilization review, documentation, and collaboration with physicians and managed care to optimize outcomes and reimbursement.

Requirements include a NYS RN license, a BSN (MSN preferred), and CCM/PRI/BLS certifications as applicable; 3-5 years of acute care RN experience with home care