RN Case Manager
Job No: 495820
Department: Medical Care Review
Local Title: RN Case Manager
Budget Title: Th Utilization Review and Quality Assurance Senior Coordinator
Work Type: Full Time
Location: Brooklyn, NY
Categories: Management and Professional, Nursing, Clinical, Patient Care
Are you looking to take your career to new heights with a leader in healthcare? SUNY Downstate Health Sciences University is one of the nation's leading metropolitan medical centers. As the only academic medical center in Brooklyn, we serve a large population that is among the most diverse in the world. We are also highly-ranked by Castle Connolly Medical, a healthcare rating company for consumers, among the top 5 leading U.S. medical schools for training doctors.
Bargaining Unit:
UUP
Job Summary:
The Department of Case Management at SUNY Downstate Health Sciences University is seeking a full-time RN 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
S alary Range:
Commensurate with experience and qualifications
COVID-19 Vaccination Requirement :
An approved COVID-19 vaccination.
E xecutive 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 info@goer.ny.gov.
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 encouraged to apply.
If you are an individual with a disability and need a reasonable accommodation for any part of the application process, or in order to perform the essential functions of a position, please contact Human Resources at ada@downstate.edu
Advertised: March 29, 2023 Eastern Daylight Time
Applications close: