RN Case Manager

TEEMA Group; City of White Plains (NY); Vor Ort; USD 90.000 - 120.000; Vollzeit

Zusammenfassung

TEEMA Group is seeking an experienced RN Care Manager in White Plains, NY to coordinate safe, efficient patient-centered care across hospital services. You will perform comprehensive assessments, care coordination, discharge planning, and utilization review to reduce readmissions and improve outcomes.

The role focuses on geriatric patients, collaboration with interdisciplinary teams, and ensuring timely access to post-acute services.

Qualifikationen

• BSN required and active RN license in state of practice.
• PRI Certification must be obtained within three months of hire.
• Strong computer proficiency and healthcare IT familiarity.
• Experience in care management or related field preferred.

Aufgaben

• Complete comprehensive initial patient assessments per Care Management policies.
• Lead multidisciplinary care coordination across intra-/inter-hospital levels.
• Coordinate transitional care planning including education and post-acute services.
• Collaborate with commercial payers and evaluate high-utilizer cases.
• Communicate patient information with healthcare team and stakeholders.
• Support goals to reduce length of stay and readmissions; improve satisfaction.

Kenntnisse

Two-way communication

Delegation

Team collaboration

Multitasking

Ausbildung

BSN

RN license

PRI Certification

Tools

Milliman

InterQual

Jobbeschreibung

The RN Care Manager plays a critical role in coordinating safe, effective, and patient-centered care across the continuum of hospital services. This position focuses on comprehensive assessment, care coordination, utilization review, and discharge planning to reduce readmissions, improve outcomes, and enhance patient and caregiver satisfaction. Working closely with interdisciplinary healthcare professionals, the RN Care Manager supports complex patient populations—particularly geriatric patients—by ensuring timely access to appropriate post-acute services and resources.

This role is ideal for experienced nurses who enjoy clinical problem-solving, collaboration, and making a measurable impact on patient outcomes and care efficiency.

Key Duties & Responsibilities

Complete comprehensive initial patient assessments in accordance with Care Management policies

Perform multidisciplinary care coordination across intra-hospital and inter-hospital levels of care

Lead transitional care planning activities, including:

• Patient and caregiver education
• Coordination of post-acute and aftercare services
• Collaboration with commercial payers
• Evaluation of high-utilizer patient root causes

Communicate and collaborate relevant patient information with appropriate members of the healthcare team

Support departmental goals related to length-of-stay reduction, readmission prevention, denial reduction, and patient satisfaction improvement

Complete documentation in accordance with departmental standards

Participate in performance improvement initiatives as needed

Perform utilization review (UR) activities in alignment with departmental policy, including:

• Commercial payer reviews
• Admission clinical reviews
• Retroactive and self-audits
• Medical necessity variance analysis

Collaborate with healthcare professionals to evaluate care needs and ensure safe discharge planning for geriatric patients across inpatient, emergency department, and surgical outpatient settings

Perform additional related duties as assigned

Required Education & Experience

Bachelor of Science in Nursing (BSN) required

Active Registered Nurse (RN) license in the state of practice

PRI Certification (must be obtained within three months of hire)

Strong computer proficiency

Desired Qualifications

Screen Certification (strongly preferred)

Care Management certification (e.g., CCM, CMC, or equivalent)

Minimum of three (3) years of clinical experience in emergency, critical care, or medical-surgical nursing

Knowledge of healthcare finance, regulatory requirements, and payer systems

Familiarity with state, local, and federal healthcare programs

Experience using Milliman or InterQual medical necessity criteria

Core Competencies

Strong two-way communication skills with the ability to clearly define expectations and actively listen

Effective delegation and team collaboration skills

Ability to remain composed under pressure and manage multiple priorities simultaneously

Physical & Mental Requirements / Work Environment

Ability to walk, stand, and sit for extended periods of time

Ability to carry necessary equipment (e.g., laptop or tablet) during rounds

Adequate manual dexterity, hand-eye coordination, and visual and auditory acuity

Ability to follow written and verbal instructions and meet regulatory requirements

Exposure to standard healthcare-related chemicals in accordance with safety guidelines

Ability to analyze complex, multidimensional problems and prioritize tasks effectively

Primary Patient Populations Served

• Adult (18–64 years)
• Geriatric (65+ years)
• Patients with complex medical, cultural, communication, developmental, or end-of-life care needs
• Patients under isolation precautions
• Bariatric patients with weight-related comorbidities

Location & Work Type

• Location: White Plains, New York
• Work Type: On-site
• Schedule: Full-time, day shift
• Monday–Friday, 9:00 a.m. – 5:00 p.m.
• Weekend rotation once per month (Saturday and Sunday)