RN Care Manager: Discharge & Utilization Expert

NYU Langone Health; Village of Patchogue (NY); On-site; USD 115,000 - 148,000; Full time

Job summary

NYU Langone Hospital—Suffolk is seeking a Care Manager – Registered Nurse for a full-time days role in Care Management. The RN Care Manager collaborates with the interdisciplinary team to implement the plan of care and transition strategies, ensuring desirable patient outcomes and efficient resource use.

The role involves utilization management, reviewing medical necessity, coordinating with physicians, and leading discharge planning to facilitate smooth transitions across settings.

Qualifications

• Current NYS registered nurse license to practice in New York.
• Case management certification from an accepted accrediting body preferred.
• Minimum 5 years of clinical experience and 3-5 years as a hospital in-patient case manager.
• Knowledge of Federal and State regulations pertaining to hospital reimbursement, utilization review, and discharge planning.
• PRI and Screen certifications preferred; familiarity with hospital care management software and EMR systems.

Responsibilities

• Demonstrates accountability for utilization management and payer communications to ensure authorization and payment for hospital stay.
• Performs admission review within 24 hours of admission using InterQual criteria to determine medical necessity.
• Communicates with attending physicians to gather information supporting medical necessity for admission.
• Lead discharge planning and transition planning from admission to discharge, coordinating with the health care team and third-party payors.
• Documents all reviews and communications in the EMR and submits reviews to payors as required by contract.
• Ensure continuity of care by coordinating with community resources and post-hospital care facilities.

Skills

NYS Registered Nurse License

Case Management Certification

Inpatient hospital experience

CDI Training

Hospital care management software

MS Office suite (Outlook/Word/Excel)

Education

BSN or MSN preferred

Tools

EMR systems

Care management software

Job description

NYU Langone Hospital—Suffolk is seeking a Care Manager – Registered Nurse for a full-time days role in Care Management. The RN Care Manager collaborates with the interdisciplinary team to implement the plan of care and transition strategies, ensuring desirable patient outcomes and efficient resource use.

The role involves utilization management, reviewing medical necessity, coordinating with physicians, and leading discharge planning to facilitate smooth transitions across settings.