CASE MANAGER-WAKEFIELD

Montefiore Health System; New York (NY); On-site; USD 1,000; Full time

Job summary

Montefiore Health System is seeking a skilled Case Manager RN for its Care Management department. This position is critical for coordinating patient care while ensuring compliance with regulations. The role includes assessing patient needs and managing clinical appeals. Ideal candidates will have strong analytical and communication skills, a BSN, and relevant experience in acute care settings.

Qualifications

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

Responsibilities

• Coordinate medical care services for patients.
• Assess appropriateness of patient care services and prepare clinical appeals.
• Compile and analyze data for utilization reviews and quality improvement.

Skills

Analytical skills

Problem-solving skills

Interpersonal communication skills

Negotiation skills

Organization skills

Time management skills

Education

BSN or related Bachelor's degree

Master's Degree (preferred)

NYS RN License

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

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: 225631Salary Range/Pay Rate:$65.38

For positions that have only a rate listed, the displayedrate is the hiringrate but could be subject to change based on shift differential, experience, education or other relevant factors.

To learn more about the “Montefiore Difference” – who we are at Montefiore and all that we have to offer our associates, please clickhere.

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