RN Care Manager

 Position Summary                         
The RN Care Manager performs the initial comprehensive assessment on admission in accordance with the Care Management Department policy, screening all patients by utilizing established tools for high risk indicators (i.e. AIMS, Geisinger, polypharmacy) to ensure high risk patient populations receive the appropriate supportive services for discharge to prevent readmission and assess all populations for potential discharge planning needs. Provides ongoing reassessment of needs throughout the hospital course. Performs UR activity per department policy.

 Essential Functions and Responsibilities Includes the Following:                              

Understands and adheres to the WPH Performance Standards, Policies and Behaviors
Completes a comprehensive initial assessment.
Performs all activities for multidisciplinary care coordination at the intra-hospital level of care and inter-hospital level of care.
Performs all transitional planning activities including but not limited to:

Patient/caregiver education
Arrangement of all aftercare
Commercial payer involvement
High utilizer patient root cause

Communicates and collaborates all relevant patient information to appropriate health team members.
Ensures department goals of LOS reduction, readmission prevention, denial reduction, and satisfaction improvement are realized.
Documents per department requirements.
Participates in Performance Improvement activities as needed.
Performs all UR activities per department policy:

Commercial payer reviews
Disposition determination,
Retro/self-audit
MC variance
Admission clinical review.

Performs all other related duties as assigned

 Education & Experience Requirements                                                                          

BSN or related Bachelor’s degree required
5 years clinical ED, critical care or med/surg experience required
Previous case management experience preferred
Knowledge of healthcare financial, regulatory, and payer issues preferred
Knowledge of state, local, and federal programs strongly preferred
Experience in use of Milliman/InterQual criteria
Registered Nurse (RN) NYS license required
PRI/Screen certification strongly preferred.
C.C.M. (Certified Case Manager) certification preferred
Computer skills essential