RN Case Manager - Utilization Management (JR232705)

<strong>To heal, to teach, to discover and to advance the health of the communities we serve.</strong>

Newburgh, New York

Montefiore St. Luke's Cornwall

<h4 class="">For 150 years, Montefiore St. Luke&rsquo;s Cornwall (MSLC) has been a cornerstone of high-quality healthcare in Orange County, fostering a healing environment through collaboration, dedicated staff, and a rich history.&nbsp;What&nbsp;started as three-bed hospital in 1875 has grown into a healthcare system with two campuses and a wide range of outpatient services.&nbsp;<br /><br /><span style="text-decoration: underline;"><a href="https://montefiore.wd12.myworkdayjobs.com/en-US/MMC/login" target="_blank" title="Candidate Home" rel="noopener noreferrer">Sign In</a></span>&nbsp;- Candidate Home<br /><span style="text-decoration: underline;"><a href="https://montefiore.wd12.myworkdayjobs.com/en-US/MMC/introduceYourself" target="_blank" title="Introduce Yourself " rel="noopener noreferrer">Introduce Yourself&nbsp;</a></span>-&nbsp;Please let us know about yourself so we can keep in touch about future job openings!<br /><strong><span class=""><br /></span>Benefits:<br /></strong>MSLC&nbsp;strives to be the employer of choice by offering comprehensive benefit packages that are designed to meet the needs of today's workforce. We are committed to assisting employees to achieve optimal health, wellness, and financial security. Our benefit packages include medical, dental, vision, and life insurance, 403(b) retirement plan, tuition reimbursement, a generous paid time off plan, as well as various other optional benefits.<strong><br /></strong></h4> https://www.montefiore.org/

keywords: position summary,patient care,coordinate,review,education,experience,skills

Full time

Overview: 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.
Responsibilities: <ul> <li>The individual in this position has primary responsibility for ensuring that care provided is at the appropriate level of care based on medical necessity.</li> <li>This position manages the medical necessity review process to ensure accurate and timely payment for services.&nbsp;</li> <li>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.</li> <li>Progression of care is managed by using bench marked evidence-based criteria (i.e., InterQual).</li> </ul>
Requirements: <strong>Education/Training</strong>: <br /><br /> <ul> <li>Graduate of NLN Accredited School of Nursing, BSN preferred.</li> <li>Ability to read, write, and communicate in English.</li> </ul> <br /> <p>&nbsp;</p> <strong>Experience</strong>: <br /><br /> <ul> <li>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.&nbsp;</li> <li>Experience with EPIC EMR.&nbsp;</li> <li>Proficiency in applying InterQual guidelines for medical necessity.</li> <li>Familiarity with processes of critical payers such as Aetna, UHC, MVP, BCBS.&nbsp;</li> <li>Must have experience forming positive, collaborative relationships with hospital staff, providers, patients, and families.</li> <li>Must demonstrate critical thinking skills to find solutions to problems, work independently, manage stress, prioritize work, and maintain calm demeanor in stressful environment.</li> </ul> <br />&nbsp;<br /><strong>Licensure:</strong>&nbsp;<br /><br /> <ul> <li>Current New York State Licensure as a Registered Professional Nurse.</li> <li>Certification in Case Management required 18 months after eligibility.&nbsp;</li> <li>NYS PRI and Screen certification required within 3 months of hire/transfer.</li> </ul>