Registered Nurse Care Manager

• Complete comprehensive patient assessments upon admission and perform ongoing reassessments throughout the patient's hospital stay.
• Identify high-risk patients using established screening tools and coordinate appropriate interventions.
• Develop individualized discharge plans that promote safe and effective transitions of care.
• Coordinate multidisciplinary care planning with physicians, nursing staff, therapists, social workers, and external providers.
• Educate patients and caregivers regarding post-discharge care plans and available community resources.
• Arrange post-acute services including home health, rehabilitation, skilled nursing, durable medical equipment, and other aftercare needs.
• Collaborate with commercial payers regarding authorizations, continued stay reviews, and discharge planning.
• Perform utilization review activities including admission reviews, payer reviews, medical necessity determinations, variance reporting, and retrospective audits.
• Support initiatives focused on:
• Reducing length of stay
• Preventing hospital readmissions
• Minimizing insurance denials
• Improving patient satisfaction
• Document assessments, care coordination activities, and discharge planning in accordance with departmental and regulatory standards.
• Participate in quality improvement and performance improvement initiatives.
• Collaborate with healthcare professionals to ensure safe discharge planning for inpatient, emergency department, surgical, and geriatric populations.
• Maintain compliance with hospital policies, regulatory requirements, and professional nursing standards.

Required Qualifications

• Active New York Registered Nurse (RN) license.
• Bachelor of Science in Nursing (BSN) required.
• Ability to obtain PRI Certification within three months of hire.
• Minimum of three years of recent clinical experience in one or more of the following:
• Medical-Surgical
• Critical Care
• Emergency Department
• Strong clinical assessment, critical thinking, and care coordination skills.
• Excellent communication, collaboration, and documentation abilities.
• Proficiency with electronic medical records and computer applications.

Preferred Qualifications

• Previous acute care Case Management experience.
• Care Management Certification (CCM, CMC, ACM, or equivalent).
• Screen Certification.
• Experience with:
• Utilization Review
• InterQual or Milliman criteria
• Healthcare reimbursement and payer regulations
• Medicare, Medicaid, and commercial insurance processes
• State, federal, and community healthcare programs

Ideal Candidate

The ideal candidate is an experienced acute care Registered Nurse who excels in care coordination, discharge planning, utilization management, and interdisciplinary collaboration. This individual demonstrates strong clinical judgment, exceptional communication skills, and a commitment to delivering high-quality, patient-centered care while ensuring safe transitions across the continuum of care.

Benefits

• Competitive compensation
• Comprehensive medical, dental, and vision insurance
• Retirement savings plan
• Paid time off
• Continuing education and professional development opportunities
• Career advancement within a highly respected healthcare organization
• Collaborative and supportive multidisciplinary work environment

Why Join This Opportunity?

Join an award-winning healthcare organization recognized for clinical excellence, outstanding patient outcomes, and an exceptional workplace culture. This role offers the opportunity to make a meaningful impact while working alongside a collaborative team dedicated to delivering high-quality care and improving the patient experience.

Pay: $126,160.32 - $160,090.32 per year Work Location: In person