RN Case Manager - Utilization Management

City/State:

Newburgh, New York

Department:

Case Management

Bargaining Unit:

Teamsters Local 445

Work Shift:

Day

Work Days:

DAYS VARY

Scheduled Hours:

Hours Vary

Scheduled Daily Hours:

Hours Vary

Pay Rate/Range:

$112,480.87 - $127,155.60

Sign-On Bonus:

N/A

The RN Case Manager Utilization Management is responsible for supporting the physician and interdisciplinary team in facilitating patient care, at the appropriate level of care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The individual in this position has primary responsibility for ensuring that care provided is at the appropriate level of care based on medical necessity. This position manages the medical necessity review process to ensure accurate and timely payment for services. This role integrates and coordinates utilization management by performing clinically based medical necessity reviews using standardized published criteria to certify medical necessity for admission and continued stay of all patients receiving care in the hospital. Progression of care is managed by using bench marked evidence-based criteria (i.e., InterQual).

Position Qualifications:

A. Education/Training: Graduate of NLN Accredited School of Nursing, BSN preferred. Ability to read, write, and communicate in English.

B. Experience: 3 years of experience as a Utilization Review/Utilization Management (UR/UM) Nurse or Nurse Case Manager with primary responsibility for UR/UM in an acute care setting required. Experience with EPIC EMR. Proficiency in applying InterQual guidelines for medical necessity. Familiarity with processes of critical payers such as Aetna, UHC, MVP, BCBS. Must have experience forming positive, collaborative relationships with hospital staff, providers, patients, and families. Must demonstrate critical thinking skills to find solutions to problems, work independently, manage stress, prioritize work, and maintain calm demeanor in stressful environment.

C. Licensure: Current New York State Licensure as a Registered Professional Nurse. Certification in Case Management required 18 months after eligibility. NYS PRI and Screen certification required within 3 months of hire/transfer.

Montefiore St. Luke's Cornwall is an equal employment opportunity employer. Montefiore St. Luke's Cornwall will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.