RN Case Manager - Multiple Positions

SUNY Downstate Medical Center; New York (NY); On-site; USD 110,000 - 124,000; Full time

Job summary

SUNY Downstate Health Sciences University in Brooklyn, NY seeks a full-time TH Utilization Review Quality Assurance Senior Coordinator / RN Case Manager to coordinate hospital case management, utilization reviews and discharge planning. The role requires NY RN licensure, a nursing degree and PRI certification, with preferred healthcare-related graduate or CM certifications.

The position involves collaboration with social work and nursing teams, adherence to regulatory documentation and ensuring

Qualifications

• Current New York State Registered Nurse Licensure is required.
• Bachelor's Degree in Nursing is required.
• PRI Certification or Case Management Certification preferred.

Responsibilities

• Provide hospital case management, utilization review and discharge planning.
• Use Milliman Care Guidelines to justify level of care and medical necessity.
• Perform initial and ongoing clinical reviews for inpatient admissions.
• Promote interdisciplinary collaboration and coordinate post-hospitalization care.

Education

Bachelor's Degree in Nursing

PRI Certification

Graduate Degree in Healthcare

Case Management Certification

Current New York State Registered Nurse Licensure

Job description

Are you looking to take your career to new heights with a leader in healthcare?SUNY Downstate Health Sciences Universityis one of the nation's leading metropolitan medical centers. As the only academic medical center in Brooklyn, we serve a large population that is among the most diverse in the world. We are also highly-ranked by Castle Connolly Medical, a healthcare rating company for consumers, among the top 5 leading U.S. medical schools for training doctors.

Job Description

The Department of Case Management at SUNY Downstate Health Sciences University is seeking a full-time TH Utilization Review Quality Assurance Senior Coordinator / RN Case Manager. The successful candidate will:

• Provide hospital case management, utilization review and discharge planning to ensure that the patient progresses through the continuum of care and discharged through a well-coordinated transition of care plan.
• Utilize standard review criteria specifically the Milliman Care Guidelines (MCG) to justify level of care, medical necessity, expected length of stay and intensity for inpatient admissions.
• Perform initial clinical reviews and continued care reviews for hospitalized patients using standardized care guidelines to determine medical necessity for inpatient admissions or for placement in other appropriate levels of care.
• Conduct an initial clinical assessment within 24 to 48 hours. Perform reassessments as necessary based on patient acuity.
• Promote interdisciplinary collaboration by providing resources to the interdisciplinary team when appropriate on issues of medical necessity and clinical documentation requirements.
• Collaborate with Departments of Social Work, Nursing and other medical teams to discuss patient treatment plan and transition of care post-hospitalization.
• Communicate with patient/family members appropriately and be cognizant of cultural facts that can affect hospital stay and discharge planning.
• Document delays or variances from expected length of stay in CarePort (Care Management Platform).
• Identify patients who were readmitted within 30-days. Assess for actual/potential risks then confer concerns to medical team and appropriate social worker. Document interaction in patients' medical record.
• Complete the Patient Review Instrument (PRI) as mandated by New York State.
• Transmit Patient Review Instrument (PRI) to facilities and MCO in order to secure authorizations for transfer to SNF and SAR.
• Facilitate concurrent request for reconsideration of potential denials. Coordinate peer interactions between SUNY University Hospital physicians and the Managed Care Organization physicians to prevent denial of reimbursements.
• Ensure patients are placed in the proper level of care by communication with the appropriate physicians
• Ensure the appropriate documents that meets regulatory requirements are in the medical record e.g. IMM forms (signed), observation notices (signed).

Qualifications

Required Qualifications

• Current New York State Registered Nurse Licensure.
• Bachelor's Degree in Nursing.
• PRI Certification.

Preferred Qualifications

• Graduate Degree in Healthcare preferred.
• Case Management Certification preferred.

SUNY Downstate Health Sciences University is an affirmative action, equal opportunity employer and does not discriminate on the basis of race, color, national origin, religion, creed, age, disability, sex, gender identity or expression, sexual orientation, familial status, pregnancy, predisposing genetic characteristics, military status, domestic violence victim status, criminal conviction, and all other protected classes under federal or state laws.

Women, minorities, veterans, individuals with disabilities and members of underrepresented groups are encouraged to apply.

If you are an individual with a disability and need a reasonable accommodation for any part of the application process, or in order to perform the essential functions of a position, please contact Human Resources [e-mail].

Job Info

• Job Schedule Full time
• Job Shift Day
• Posting Date 07/13/2026, 06:00 AM
• Job Identification 497045
• Grade NSSL4 - 08
• Days of Week Weekdays
• Shift Start Time 9:00am
• Shift End Time 5:00pm
• Union Name UUP
• Minimum Base Salary 110,000
• Maximum Base Salary 124,400
• Additional Compensation 1 Location Pay
• Additional Compensation 1 Amount 4,150
• Other Job Title RN Case Manager - Multiple Positions