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 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.
• The RN Care Manager collaborates with all Health Care professionals to evaluate the needs and the safe discharge of all geriatric patients including but not limited to inpatients, emergency department and surgical outpatients.
• Performs all other related duties as assigned
  

Education & Experience Requirements

• BSN required for all RNs hired after 1/1/18
• All RNs hired before 1/1/18 will be required to have their BSN (or MSN) by 12/31/21.
• Registered Nurse (RN) NYS license required
• PRI Certification (PRI certification to be obtained within 3 months of initial employment)
• Screen certification strongly preferred
• A Care Management certification preferred (i.e. CMC, CCM etc.)
• 3 years clinical ED, critical care or med/surg experience preferred
• 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
• A Care Management certification preferred (i.e. CMC, CCM etc.)
• Computer skills essential
  
  

Core Competencies

• Demonstrates ability to establish two-way communication by clearly defining expectations, communicating utilizing a variety of methods, actively listening to ideas and concerns and responding in an appropriate manner.
• Demonstrates ability to delegate responsibilities appropriately.
• Demonstrates ability to retain composure under stress and perform multitasking functions.
  
  

Physical/Mental Demands/Requirements & Work Environment

• May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital’s SDS (Safety Data Sheet) data base and may be accessed through the hospital’s Intranet site (Employee Tools/SDS Access). A copy of the SDS data base can also be found at the hospital switchboard, saved on a disc.
• Must be physically able to walk, stand and/or sit for extended periods of time, with the ability to carry necessary equipment (i.e., iPad or laptop) on rounds. Must be able to perform difficult manipulative, arm-hand steadiness and hand-eye coordination skills. Must be able to meet all regulatory requirements. Demonstrates ability to follow written and oral instructions required for the position.
• Demonstrates ability to analyze multidimensional problems into component parts and sort out tasks in priority order to solve the problem.
• Must be able to see object closely and far away, hear normal sounds with some background noise. Communicates effectively verbally and in writing.
  
  

Primary Population Served

Check Appropriate Box(s) Below

• Neonatal (birth – 28 days)
• Patients with exceptional communication needs
• Infant (29 days – less than 1 year)
• Patients with developmental delays
• Pediatric (1 – 12 years)
• Patients at end of life
• Adolescent (13 – 17 years)
• Patients under isolation precautions
• Adult (18 – 64 years)
• Patients with cultural needs
• Geriatric (> 65 years)
  
  

☒All populations

• Bariatric Patients with weight related comorbidities
• Non-patient care population
  
  

The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of White Plains Hospital.

Salary Range: $126,160.32-$160,090.32 (Based on full-time employment)