Duties :
Screens ED patients, using Milliman criteria, for level of care appropriateness based on medical necessity determination (admission, observation, TCU / SNF, discharge).
Work with ED physicians, ED social worker, and Hospitalists to determine appropriate level of care. Identifies patients presenting to the ED who were discharged within the previous 30 days.
Complete PRIs to facilitate patient transfer to appropriate setting. Serves as a liaison between the patient and facility / physician to ensure a continuum of quality patient care throughout the hospitalization.
Assesses, plans, oversees, and evaluates the appropriateness of care throughout admission and hospitalization of the patient.
Performs concurrent utilization management using evidence based medical necessity criteria. Submits data to management regarding case management and / or quality initiatives.
Serves as an in-patient liaison - planning, assessing, implementing, and evaluating patient in collaboration with the health care team.
Conducts chart review for appropriateness of admission, facilitates throughput and completes PRIs as necessary. Conducts clinical reviews and interacts with third party payers to obtain approval of hospital days, pre-certification, and post-discharge eligibility in relation to clinical course.
Ensures compliance with current state, federal, and third-party payer regulations. Performs related duties as required.
Qualifications :
Bachelor’s degree required. NYS Registered Nurse License required. Minimum 5 years clinical nursing experience required, PRI certification preferred.
Case Management experience preferred.
Registered Nurse Care Manager / Case Management (RN)
Registered Nurse (RN) Team Member Luxor Nursing and Rehabilitation at Sayville is seeking Part-Time RN Team Members to work in our skilled nursing facility. ...
Licensed Practical Nurse Care Manager / Case Management (LPN)
Licensed Practical Nurse (LPN) Luxor Nursing and Rehabilitation at Mills Pond is actively seeking Licensed Practical Nurses to work the 7-3 shift in our Skilled Nursing Facility in St. ...
Licensed Practical Nurse Care Manager / Case Management (LPN)
Licensed Practical Nurses- LPN Luxor Nursing and Rehabilitation at Sayville is actively hiring LPN Team Members to work either the evening or night shift at our skilled nursing facility located in Sayville, NY. ...
Registered Nurse - Behavioral Health Assistant Manager
Nurses with experience in any of the following areas are strongly encouraged to apply: Assistant Nurse Manager, Behavioral health, CNO, Charge, Clinical Nurse Coordinator, Counseling, Director, Intake, Manager, Medication side effects, PTSD, Psychosomatic Medication Interactions, Suicide and self ha...
Staff - Manager Registered Nurse (RN) - Home Health - $110K-120K per year
Core Medical-Perm is seeking a Registered Nurse (RN) Home Health Manager for a nursing job in Medford, New York. Streamlined communication and feedback from sometimes difficult to reach hiring managers. ...
Registered Nurse Case Manager
NYS Registered Nurse License required. Submits data to management regarding case management and/or quality initiatives. Case Management experience preferred. ...
Telephonic Nurse Case Manager I
Telephonic Nurse Case Manager I. Telephonic Nurse Case Manager I. Certification as a Case Manager is preferred. Minimum 2 years "telephonic" Case Management experience with a Managed Care Company preferred. ...
Unit Manager RN Registered Nurse
RN Registered Nurse Unit Manager position for our Sub Acute Rehab. Qualifications and role of a Registered Nurse Unit Manager:. Benefits For an RN Registered Nurse:. Come join us as an RN Unit Manager and turn your work dreams into reality. ...
Nurse Case Manager I
Certification as a Case Manager is preferred. Certification as a Case Manager and a BS in a health or human services related field preferred. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Unless specified as primarily virtual...
Nurse Case Manager
We are currently seeking a Nurse Case Manager for our Queens Residences. Are you a Registered Nurse seeking a new opportunity? Are you tired of working 12 hour shifts? Want a change from the hospital setting? Are you seeking a full time opportunity with flexible hours? . ...