RN Care Manager

TEEMA Group; City of White Plains (NY); In loco; USD 85.000 - 110.000; Tempo pieno

Descrizione del lavoro

TEEMA Group seeks a Clinical Coordinator / RN Care Manager in White Plains, NY to perform initial comprehensive assessments and coordinate multidisciplinary care from admission through discharge. You will educate patients and caregivers, arrange aftercare, and involve Commercial payers as needed.

The role emphasizes improving LOS, reducing readmissions, preventing denials, and participating in Performance Improvement activities, with required BSN and NYS RN licensure.

Competenze

• BSN required.
• Registered Nurse (RN) NYS license required.
• PRI Certification must be obtained within 3 months of employment.
• Screen certification strongly preferred.
• Clinical experience in ED, critical care, or med/surg is preferred.
• Knowledge of healthcare financial, regulatory, and payer issues is preferred.
• Experience with Milliman/InterQual criteria is beneficial.

Mansioni

• Performs an initial comprehensive assessment on admission.
• Coordinates multidisciplinary care at intra- and inter-hospital levels.
• Conducts transitional planning including patient education, aftercare arrangements, and payer involvement.
• Communicates patient information to the health care team.
• Aims to reduce LOS, prevent readmissions, and improve satisfaction.
• Participates in Performance Improvement activities and related reviews.

Conoscenze

Care coordination

Discharge planning

InterQual criteria knowledge

Payer knowledge

Team collaboration

Formazione

BSN

RN NYS license

PRI Certification (within 3 months)

Screen certification (preferred)

Strumenti

Milliman/InterQual criteria

Descrizione del lavoro

The Clinical Coordinator / RN Care Manager performs the initial comprehensive assessment on admission in accordance with the Care Management Department policy, screening all patients by utilizing established tools for high-risk indicators to ensure high-risk patient populations receive the appropriate supportive services for discharge to prevent readmission and assess all populations for potential discharge planning needs. Provides ongoing reassessment of needs throughout the hospital course. Performs UR activity per department policy.

Essential Functions and Responsibilities

• Understands and adheres to the WPH Performance Standards, Policies, and Behaviors.
• Completes a comprehensive initial assessment.
• Performs all activities for multidisciplinary care coordination at the intra-hospital level of care and inter-hospital level of care.
• Performs all transitional planning activities including, but not limited to:
• Patient/caregiver education
• Arrangement of all aftercare
• Commercial payer involvement
• High utilizer patient root cause
• Communicates and collaborates all relevant patient information to appropriate health team members.
• Ensures department goals of LOS reduction, readmission prevention, denial reduction, and satisfaction improvement are realized.
• Participates in Performance Improvement activities as needed.
• Commercial payer reviews
• Retro/self-audit
• MC variance
• Admission clinical review
• The RN Care Manager collaborates with all health care professionals to evaluate the needs and the safe discharge of all geriatric patients including, but not limited to, inpatients, emergency department, and surgical outpatients.
• Performs all other related duties as assigned.

Education & Experience Requirements

• BSN required
• Licensure: Registered Nurse (RN) NYS license required.
• Certifications:
• PRI Certification (must be obtained within 3 months of initial employment).
• Screen certification (strongly preferred).
• Clinical Experience: 3 years clinical ED, critical care, or med/surg experience preferred.
• Technical Knowledge: * Knowledge of healthcare financial, regulatory, and payer issues preferred.
• Knowledge of state, local, and federal programs strongly preferred.
• Experience in use of Milliman/InterQual criteria.