CASE MANAGER-WAKEFIELD

Davita Inc.; New York (NY); On-site; USD 1,000; Full time

Job summary

Join a leading hospital as a Case Manager RN in the Care Management department, providing exceptional patient care and ensuring regulatory compliance. This role emphasizes patient assessment, care coordination, and documentation for utilization reviews, necessitating a solid nursing background and collaborative skills.

Qualifications

• 3-5 years recent acute care clinical experience preferred.
• Certification in Utilization Review or Case Management preferred.

Responsibilities

• Coordinate medical care services for patients.
• Ensure efficient resource utilization and deliver high-quality care.
• Assess patient care services and prepare clinical appeals for denied claims.

Skills

Analytical skills

Problem-solving skills

Communication skills

Organization skills

Interpersonal skills

Education

BSN or a bachelor's degree in a related field

Master's Degree

NYS RN License

Tools

Electronic clinical information system

Windows-based software applications

Job description

We are offering an exciting opportunity to join our esteemed team at Montefiore Wakefield Campus, a Magnet designated hospital recognized for its excellence in patient care.

Our Care Management department is currently seeking a highly skilled Case Manager RN to provide top-notch care to patients.

The Case Manager, RN, plays a critical role in coordinating medical care services for patients. This includes ensuring efficient utilization of resources, delivering high-quality patient care, and maintaining compliance with relevant regulatory, accrediting, and contractual requirements.

Key responsibilities include assessing the appropriateness of patient care services, preparing and submitting clinical appeals for denied claims, and compiling and analyzing data to support utilization reviews, quality improvement initiatives, and other areas as assigned.

Requirements:

• BSN or a bachelor's degree in a related field Required
• Master's Degree preferred
• NYS RN License required
• PRI assessor number required prior to end of 3-month probationary period
• 3-5 years recent acute care clinical experience preferred
• Experience in utilization management preferred
• Experience in a managed care organization preferred
• Certification in Utilization Review or Case Management preferred
• Analytical skills, problem-solving skills, conflict resolution and negotiation skills
• Demonstrated knowledge of federal, state and commercial/third-party regulations related to utilization management functions, discharge planning and associated processes
• Demonstrated knowledge of quality/performance improvement tools and techniques
• Demonstrated knowledge of utilization and case management principles
• Experience in the application of utilization management decision support criteria preferred
• Computer skills including data entry, word processing, and electronic messaging
• Experience in the use of Windows-based software applications
• Experience in the use of an electronic clinical information system preferred
• Excellent verbal, written and interpersonal communication skills, as well as a commitment to interdisciplinary teamwork
• Excellent organization skills, teamwork skills and time management skills
• Expert clinical knowledge of disease processes to identify care needs
• Understanding of the health care delivery system and its sites of care, delivery models, and the roles of various providers and health care professionals
• Experience in interpreting and applying benefit coverage rules and assessing coordination of benefits guidelines and managed care regulations required

Additional Details:

• Department: Care Management
• Bargaining Unit: 1199 RN
• Campus: WAKEFIELD
• Employment Status: Regular Full-Time
• Address: 600 East 233rd Street, Bronx
• Shift: Day
• Scheduled Hours: 9 AM-5 PM
• Req ID: 225631
• Salary Range/Pay Rate: $65.38

For positions with only a rate listed, the displayed rate is the hiring rate but could be subject to change based on shift differential, experience, education or other relevant factors.

To learn more about the "Montefiore Difference" and all that we offer our associates, please click here.

Montefiore is an equal employment opportunity employer. We recruit, hire, train, transfer, promote, layoff, and discharge associates in all job classifications without regard to race, color, religion, creed, national origin, alienage or citizenship status, age, gender, disability, sexual orientation, gender identity, genetic predisposition, pregnancy, military status, marital status, or any other characteristic protected by law.