RN Full-time
Northwell Health

Case Manager, RN- Case Management

$61 / hour
166750

Job Description

Serves as liaison between the patient and facility/physician. Ensures a continuum of quality patient care throughout hospitalization and oversees provisions for patient's discharge. Assesses, plans, oversees and evaluates the appropriateness of care throughout admission and hospitalization of the patient.

Job Responsibility

  • * Facilitates patient management throughout hospitalization.
    • Participates in patient management rounds and patient centered meetings.
    • Identifies potential delays and resolves issues with appropriate departments.
    • Identifies appropriate utilization of Social Work Services and makes referrals when appropriate.
    • Confers with physician regarding referrals for Physical Therapy, nutrition, speech and swallow.
  • * Serves as an in-patient liaison - planning, assessing, implementing and evaluating patient in collaboration with the health care team.
    • Serves as a resource to the health care team regarding quality, utilization of clinical resources, payer, and reimbursement issues.
    • Works with on-site screeners in transitioning patients to appropriate post discharge settings.
    • Collaborates with payers, providing all necessary clinical documentation for the maximization of benefits.
    • Serves as a liaison to patient, family, admitting, primary care physician, health care team, and hospital departments.
    • Collaborates with and provides feedback to the primary care physician and multidisciplinary team regarding patient's status with regard to length of stay, utilization of resources and discharge status.
  • * Provides support to the in-patient health care team as well as to patient and family regarding all aspects of admission, hospitalization and discharge plan.
    • Involves patient and/or family in discussion and planning for anticipated need for care following discharge.
    • Ensures patient and/or family are given information regarding their choices regarding transferring the patient to another level of care according to regulatory standards.
  • * Performs concurrent utilization management using Interqual criteria.
    • Conducts chart review for appropriateness of admission and continued length of stay.
    • Contacts 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.
    • Identifies patients for Alternate Level Care (ALC) care list and notifies appropriate health team members.
    • Communicates with insurance companies and physicians regarding utilization issues.
    • Utilizes important message from Medicare (IMM) when appropriate.
    • Ensures managed care reviews are up to date and accurately reflect patient's clinical progress and acute needs.
  • * Participates in the quality management of patient care outcomes.
    • Submits data to management regarding case management and/or quality initiatives.
    • Participates in data collection regarding patient's length of stay, utilization of clinical resources, IPRO citations including appropriate recommendations and re-admission within 30 days.
  • * Initiates appropriate discharge planning as supported by initial assessment at time of admission
    • Reviews patient's chart.
    • Assesses each patient physically, psychosocially and financially.
    • Assesses patient's support system to facilitate appropriate discharge to community.
    • Substantiates, with the physician, the need for home care services.
    • Coordinates procurement of any supplies, equipment or home lab work needed by patient to evaluate discharge.
    • Arranges for post-hospital transportation, when indicated.
    • Interacts and coordinates with community agencies, families, vendors facilities and institutions to facilitate patient discharge.
  • * Documents the case management process in the medical record.
    • Completes and documents a psychosocial assessment on the patient.
    • Documents on-going processes of patients' hospitalization.
    • Documents finalized discharge plan and disposition.
    • Completes applicable areas of the Patients Discharge Instruction Sheet and the Patient Transfer Sheet.
    • Ensures Patient Review Instrument (PRI) is completed and reflects clinical profile of the patient.
    • Ensures case management sheet is current and accurate.
  • * Performs related duties, as required.
  • ADA Essential Functions
Job Qualification

  • Bachelor's Degree in Nursing, required.
  • Current license to practice as a Registered Professional Nurse in New York State.
  • Case Management Certification, preferred.
  • Minimum of one (1) year related experience, required. Experience in case management and clinical pathways, variance analysis and trending, quality management/utilization review and home care/discharge planning, preferred.
  • Keeps abreast of developments in the field and serves as a resource to other staff.
  • Patient Review Instrument certification required.

Additional Site-specific Qualifications May Apply

  • Additional Salary Detail The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).

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All newly hired nurses to the NICU, L&D, and Mother-Baby must receive this certification within 6 months. Effective 10/31/25 all RNs working on 5I are required to have NRP. Experienced RNs will have 6 months to obtain and new graduates will have 12 months. All registered nurses and advanced practice nurses providing direct oncology care must demonstrate one of the following: Current cancer-specific certification in the nurse’s specialty by an accredited certification program. Oncology nursing certifications that qualify include, but are not limited to: AOCNP®, AOCNS®, AOCN®, BMTCN®, CPHON®, CPON®, CBCN® OCN® or Ongoing education by earning 36 cancer-related continuing education nursing contact hours every 3 years (maintained by department manager) Registered Nurses in the Emergency Department must complete de-escalation training within 1 year of hire to transfer to the Emergency Department. Successful completion of Department and Unit Orientation Program. Core Competencies Teamwork & Adaptability Acts as a Professional Role Model Assessment Skills Excellent Communication Skills (both verbal and written) Attention to Detail Planning & Organizing Sound Problem-Solving, Judgment and Decision-Making Skills Stress Tolerance Physical/Mental Demands/Requirements & Work Environment May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital’s SDS (Safety Data Sheet) database and accessed through the hospital’s Intranet site (Employee Tools/SDS Access). A copy of the SDS database can also be found at the hospital switchboard, saved on a disc. Position requires ability to move about freely at least 85 per cent of the time. Must be able to remain stationary for extended/prolonged periods Frequently moves/transports objects up to fifty (50) pounds and must be able to move patients of all weights with a minimum of one (1) assist or assistive device/equipment Must be able to work in environment with continuous interruptions Must be able to assess and respond to rapidly changing situational needs of patients, department and hospital Must be able to adapt in a high stress and fast-paced environment with multiple interruptions Must be able to detect sounds and respond to emergency sounds/signals at all times Must be able to constantly operate computer, equipment and other devices Position requires ability to concentrate on fine detail with interruptions and attend to tasks for more than sixty (60) minutes at a time. Individual must be able to understand and relate to theories behind several related concepts and remember multiple tasks given during the course of a day. Primary Population Served Check Appropriate Box(s) Below Neonatal (birth – 28 days) Patients with exceptional communication needs Infant (29 days – less than 1 year) Patients with developmental delays Pediatric (1 – 12 years) Patients at end of life Adolescent (13 – 17 years) Patients under isolation precautions Adult (18 – 64 years) Patients with cultural needs Geriatric (> 65 years) ☒All populations Bariatric Patients with weight related comorbidities Non-patient care population The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of White Plains Hospital. Salary Range: $117,695-$152,756 (Based on FT hours)