Registered Nurse (RN) - Case Management
SUNY Downstate Medical Center
Brooklyn, NY
days
Sign-On Bonus

Case Manager

The Department of Case Management at SUNY Downstate Health Sciences University is seeking a full-time Case Manager / TH Utilization Review and Quality Assurance Senior Coordinator. The successful candidate will: * Review patient records for chief complaints and sign and symptoms of disease to justify Medical Necessity for acute care treatment. * Ensure that patients are in the appropriate level of care based on Milliman Care Guidelines (MCG). * Conduct brief clinical assessment within 48 hours of admission or as patient acuity allows. * Complete clinical reviews and forward to MCOs within 48 hours of admission. * Provide critical feedback (need for upgrading/downgrading, GMLOS) as per established Care guidelines to members of the health care team via participation in daily multidisciplinary rounds on assigned unit. * Conduct routine comprehensive reassessments of clinical status with documentation in the EMR. * Identify barriers to achieving patient's goals and completion of discharge plan. * Complete Readmission screen in the Care Management Module (CarePort). * Conduct Utilization review via Chart Review. * Conduct timely concurrent reviews and responses to third party payors request for clinical reviews. * Work collaboratively with ED Case Managers and Social Workers to facilitate discharge plans. * Facilitate Peer-Peer reviews with documentation in the Care Management Module. * Ensure that 24 hour notices and IMM notices are distributed and signed timely 48 hours prior to discharge. * Complete PRIs and forward SAR/SNF after patient/family section. Required Qualifications: * Current New York State Registered Nurse Licensure. * Bachelor's Degree in Nursing. * PRI Certification. Preferred Qualifications: * Graduate Degree in Healthcare preferred. * Case Management Certification preferred. Work Schedule: Monday to Friday; 8:00am to 4:00pm Salary Grade/Rank: SL-4 Salary Range: Commensurate with experience and qualifications COVID-19 Vaccination Requirement: An approved COVID-19 vaccination. Executive Order: Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation. If such information has been requested from you before such time, please contact the Governor's Office of Employee Relations at (518) 474-6988 or via email at [email protected]. Equal Employment Opportunity Statement: SUNY Downstate Health Sciences University is an affirmative action, equal opportunity employer and does not discriminate on the basis of race, color, national origin, religion, creed, age, disability, sex, gender identity or expression, sexual orientation, familial status, pregnancy, predisposing genetic characteristics, military status, domestic violence victim status, criminal conviction, and all other protected classes under federal or state laws. Women, minorities, veterans, individuals with disabilities and members of underrepresented groups are encourage