RN/Case Manager-MSH-Case Management-FT-Weekdays/Weekends/Holidays

Mount Sinai Health System; New York (NY); On-site; USD 74,794 - 106,525; Full time

Job summary

A leading healthcare provider in New York is seeking a dedicated RN/Case Manager to oversee case management for patients. The position involves assessing clinical needs, collaborating with a multidisciplinary team, and planning for patient discharges. Potential candidates should hold a Bachelor's degree in Nursing, possess a current NYS RN license, and demonstrate experience in homecare or case management. Competitive hourly compensation is offered ranging from $65.81.

Qualifications

• Bachelor’s degree in Nursing required; Master's preferred.
• Previous experience in homecare or case management desirable.
• Current NYS RN nursing license is mandatory.

Responsibilities

• Manage case for assigned patients and ensure appropriate level of care.
• Collaborate with physicians and interdisciplinary teams.
• Document all clinical reviews in the system.

Skills

Assessment of clinical needs

Interdisciplinary collaboration

Utilization review knowledge

Discharge planning

Education

Bachelor's Degree in Nursing

Master's Degree in Nursing

Tools

Case Management Documentation system

Job description

RN/Case Manager MSH Case Management FT Weekends/Weekdays/Holidays

Description

The Case Manager (CM) will be responsible for all aspects of case management for an assigned group of patients to determine the appropriateness of the Level of Care, assist in the development of the plan of care, ensure that the plan is implemented timely, and identify the expected length of stay (ELOS). The CM works collaboratively with physicians, social workers, clinical nurses, home care services, and other members of the interdisciplinary team as needed. The CM actively participates in specific clinical initiatives focused on reducing the length of stay (LOS), improving efficiency, quality and resource utilization. Assignment will be by units/clinical areas of practice and may require responsibility on other units/services.

Responsibilities

• Principle Duties and responsibilities include, but are not limited to:
• Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve optimal patient outcomes and appropriate reimbursement for the organization.
• Performs continued stay reviews utilizing standardized criteria to justify continued inpatient stay.
• Collaborates with Physician and other clinicians to expedite diagnostic testing, treatment and consultations.
• Documents all clinical reviews in Case Management Documentation system.
• Supports the mission, vision, philosophy and goals of the Medical Center.
• Case Management: The CM process will include:
• Assessment of the patient's clinical, psychosocial, and functional status in collaboration with the interdisciplinary team.
• Identification and documentation of variances affecting the LOS and the discharge planning process.
• Conducts follow-up of any delays in treatment or reporting of results.
• Planning/developing specific goals with the physician, interdisciplinary team, and the patient and/or family.
• Implementation and coordination of specific activities, strategies, and interventions to move the patient through the continuum of care.
• Documentation of outcomes achieved and identified internal and external barriers.
• Identifies reasons for readmissions and collaborates with interdisciplinary team on strategies to reduce readmission rate.
• Appropriately identifies and refers cases to the physician advisor to support timely progression of patients along the continuum of care and appropriate discharge planning.
• Interacts with patient/family to discuss plan of care and coordination of services based on clinical needs and available resources.
• Utilization Review:
• Maintains a working knowledge of the UR (Utilization Review) requirements of each payor within the patient population;
• Provides the clinical information requested by the managed care companies as part of the concurrent review in a timely fashion.
• Provides clinical information requested by the managed care companies in accordance with contractual agreements.
• Works collaboratively with physicians and managed care companies on concurrent denial appeals
• Communicates clinical information to the payor, as needed, coordinating direct communication between physician and payor Medical Director as required.
• In psychiatry, the CM will document UR notes in the medical record as per OMH guidelines.
• Discharge Planning:
• Responsible for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission).
• Obtains authorizations from managed care companies for post-discharge services.
• Assess for clinical readiness and completes the Hospital and Community Patient Review Instrument (PRI) for patients requiring Residential Health Care Facility placement.
• Liaison with financial department for current insurance coverage.
• Collaborates and participates in the appeals process with all members of the interdisciplinary team.
• Collaborative Relationships:
• Develops and maintains effective working relationships with interdisciplinary team and Case Managers within the managed care organizations.
• Participates in nursing orientation.
• Interfaces with other departments in the Medical Center.

Qualifications

Education Requirements

Bachelor’s Degree in Nursing; Master’s preferred.

Experience Requirements

Previous experience in homecare, long term care or utilization review preferred.

Discharge Planner or Case Manager preferred.

Manager or a minimum of 3-5 years experience as a RN in an acute care setting.

Licensing And Certification Requirements

Current NYS RN nursing license.

CCM certification preferred. Re-credentialing of CCM status expected.

PRI Certification (to be obtained within 1 year)

BLS – Basic Life Saver (AHA)

Collective bargaining unit

NYSNA-MSH

Employer Description

Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai’s unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual. At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history. Mount Sinai Health System is one of... (full employer description omitted for brevity)

Equal Opportunity Employer

The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.

Compensation

The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $65.8112 - $65.8112 Hourly. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.