Travel Nurse RN - Case Manager in White Plains, NY

Job Title : RN Care Manager Profession : Registered Nurse Specialty : Case Management Duration : Permanent Shift : Days Hours per Shift : 24 hours per week Experience : 3 years clinical experience preferred; previous case management experience preferred License : Registered Nurse license required Certifications : BSN required; PRI Certification (to be obtained within 3 months of initial employment); Care Management certification preferred Must-Have : - BSN - Registered Nurse license - PRI Certification Description : The RN Care Manager performs the initial comprehensive assessment on admission in accordance with the Care Management Department policy. The RN screens all patients by utilizing established tools for high-risk indicators to ensure high-risk patient populations receive appropriate supportive services for discharge to prevent readmission. The RN assesses all populations for potential discharge planning needs. The RN provides ongoing reassessment of needs throughout the hospital course. The RN performs Utilization Review (UR) activity per department policy. Essential Functions and Responsibilities include the following : The RN understands and adheres to the Performance Standards, Policies, and Behaviors. The RN completes a comprehensive initial assessment. The RN performs multidisciplinary care coordination activities at the intra and inter-hospital level of care. The RN performs transitional planning activities including patient / caregiver education and arrangement of all aftercare. The RN facilitates commercial payer involvement and addresses high utilizers' root causes. The RN communicates and collaborates all relevant patient information to appropriate health team members. The RN ensures department goals of length of stay reduction, readmission prevention, denial reduction, and satisfaction improvement are realized. The RN documents per department requirements. The RN participates in Performance Improvement activities as needed. The RN performs all Utilization Review activities per department policy, including commercial payer reviews, disposition determination, retro / self-audit, and admission clinical review. The RN collaborates with all healthcare professionals to evaluate the needs and ensure the safe discharge of all patients, including inpatients and surgical outpatients. The RN performs all other related duties as assigned. Education & Experience Requirements : BSN required for all RNs hired after January 1, 2018. All RNs hired before January 1, 2018, will be required to obtain a BSN by December 31, 2021. PRI Certification must be obtained within 3 months of initial employment. Knowledge of healthcare financial, regulatory, and payer issues preferred. Knowledge of state, local, and federal programs strongly preferred. Experience in the use of Milliman / InterQual criteria is preferred.