Shift : M-F 9A-5P with a weekend rotation ( Sat & Sun)Sign On Bonus : 5000Description : The RN Care Manager performs the initial comprehensive assessment on admission in accordance with the Care Management Department policy, screening all patients by utilizing established tools for high risk indicators (i.
e. AIMS, Geisinger, polypharmacy) to ensure high risk patient populations receive the appropriate supportive services for discharge to prevent readmission and assess all populations for potential discharge planning needs.
Provides ongoing reassessment of needs throughout the hospital course. Performs UR activity per department policy.Essential Functions and Responsibilities : Understands and adheres to the Facility Performance Standards, Policies and BehaviorsCompletes a comprehensive initial assessment.
Performs all activities for multidisciplinary care coordination at the intra-hospital level of care and inter-hospital level of care.
Performs all transitional planning activities including but not limited to : Patient / caregiver educationArrangement of all aftercareCommercial payer involvementHigh utilizer patient root causeCommunicates and collaborates all relevant patient information to appropriate health team members.
Ensures department goals of LOS reduction, readmission prevention, denial reduction, and satisfaction improvement are realized.
Documents per department requirements.Participates in Performance Improvement activities as needed.Performs all UR activities per department policy : Commercial payer reviewsDisposition determination,Retro / self-auditMC varianceAdmission clinical review.
Performs all other related duties as assigned.Education & Experience Requirements BSN or related Bachelor's degree required5 years managerial experience within the acute hospitalPrevious case management experience preferredKnowledge of healthcare financial, regulatory, and payer issues preferredKnowledge of state, local, and federal programs strongly preferredExperience in use of Milliman / InterQual criteriaCertification / License : Registered Nurse (RN) NYS license requiredPRI / Screen certification strongly preferred.
C.C.M. (Certified Case Manager) certification preferredComputer skills essential
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