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Job description
Key Responsibilities:
Comprehensive Assessments: Perform initial and ongoing comprehensive clinical evaluations upon admission to identify specific discharge needs and track progress throughout the hospital course.
Multidisciplinary Coordination: Manage all facets of care coordination at both the intra-hospital and inter-hospital levels, working closely with an integrated health team.
Transitional Planning: Design and execute complex discharge and transitional care plans, including arranging necessary aftercare, leading patient/caregiver education, and managing commercial payer involvement.
High-Risk Intervention: Perform root-cause analysis for high-utilizer patient populations to deploy preventative strategies and reduce readmission rates.
Utilization Review (UR): Conduct thorough clinical reviews using established guidelines (such as Milliman or InterQual) to manage commercial payer reviews, disposition determination, retro/self-audits, and admission clinical assessments.
Geriatric Advocacy: Collaborate across specialties to evaluate the specific needs and safe discharge pathways for geriatric patients across inpatient floors, the Emergency Department, and surgical outpatient settings.
Quality & Performance: Actively document care milestones per department compliance standards and participate in targeted performance improvement activities.
Other duties as assigned.
Required Qualifications
Experience: Minimum of 3 years of clinical acute care experience required.
Education: Bachelor of Science in Nursing (BSN) required.
Licensure: Current New York State (NYS) Registered Nurse License required.
Certification: Must obtain PRI Certification within three (3) months of initial employment.
Technical Literacy: Essential computer proficiency and data entry skills required.
Desired Qualifications
Clinical Specialty: 3 years of clinical experience specifically within an Emergency Department (ED), Critical Care, or Medical-Surgical environment is highly preferred.
Case Management Background: Previous dedicated case management experience within an acute care hospital setting.
Specialty Certifications: Active Care Management credentialing (e.g., CCM, CMC) and Screen Certification are strongly preferred.
Industry Acumen: Comprehensive knowledge of healthcare financial structures, state/federal/local regulatory programs, and commercial payer issues.
System Knowledge: Hands-on experience utilizing InterQual or Milliman Criteria for utilization review.
Location and Work Type
Work Setting: Hospital-Based Case Management Department
Location: White Plains, NY area
Work Type: Full-Time | Direct Hire
Schedule: Monday – Friday | 9:00 AM – 5:00 PM (Day Shift)
Rotation: Saturday and Sunday rotation required once per month.
Benefits: Full suite of comprehensive health benefits and a competitive retirement plan.
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Who can apply
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