Position Summary At Stony Brook Medicine, a RN Case Manager is a valuable member of our team who provides clinical services to our patient population. Qualified candidates will demonstrate superior patient care and possess outstanding communication skills while adhering to our high standard of excellence.
Duties Completes utilization review screen for inpatient and observation cases. Activity includes UR from the Emergency Room or on the unit to ensure guidelines are reviewed and the plan of care is discussed with the team. Works closely with the Case Managers and Social Workers on the units and reviews findings with them. Ensures that patients are placed in the correct level of care from initial assessment point. Follows cases for authorization for inpatient stay.
Staff reviews short stay, long stay and complex cases to ensure a safe discharge plan. Completes retrospective review, one- and two-day short stay reviews and other projects as assigned. Identifies, follows and documents avoidable delays in the Care Management Program. Reviews and documents patients readmitted within thirty days. Documents overutilization of resources and services.
All Medicare cases are reviewed for level of care on admission. Reviews with the attending any patient who does not meet inpatient criteria for admission. Follows the process for Code 44 on Medicare patients and on all other payers.
Actively participates with the physician and payer to prevent denials. Reviews cases for potential change in level of care with the CM and physician.
Communicates with the transferring hospital, patient access and physicians and payers for authorization prior to transfer from other hospitals.
Maintains consistent documentation in the EMR regarding acuity, plan of care and communication with the team. Charting includes data for authorization and data management.
Reviews cases daily from admission through discharge to prevent denials. This includes patient and family contacts, insurance authorizations, tests, procedures, community resources, etc.
Assists with coordination for discharge planning including patient and family education with the interdisciplinary team. Coordinates transitional care planning for outpatient resources, prepares PRI for early referrals, and contacts agencies and facilities throughout the hospital stay.
Actively involved in performance improvement activities including program development, data collection and analysis.
Maintains a high level of customer service.
All unit coverage as needed and other duties as required.
Required Qualifications Bachelor’s degree or ongoing nursing degree with an RN license and a minimum of five years working in a hospital setting.
Good understanding of the admission/discharge process.
Excellent interpersonal skills for working with all team members.
Accurate documentation and ability to prioritize work and follow up with cases.
Preferred Qualifications Certification in Case Management, Utilization Management, Quality, Coding, Risk, or MCG.
Working knowledge of MCG or InterQual; PRI certification.
Knowledge of regulatory requirements.
Bilingual.
Recent experience in tertiary care.
Experience in pediatrics, NICU, mother/baby or ED settings.
Leadership skills.
Master’s degree preferred.
Special Notes Verification of degree (e.g., diploma or official transcript) is required for this role. Upload of documentation must be included with your application for consideration.
Posting Overview This position will remain posted until filled or for a maximum of 90 days. An initial review of all applicants will occur two weeks from the posting date. Candidates are advised that for full consideration, applications must be received before the initial review date.
Additional Requirements Must successfully complete a pre‑employment physical examination and obtain medical clearance from Stony Brook Medicine’s Employee Health Services.
Complete an electronic reference check with a minimum of three professional references.
Must successfully complete a 4‑panel drug screen.
Must meet regulatory requirements for pre‑employment screenings.
Provide a copy of any required New York State license(s)/certificate(s).
Salary Base salary range: $104,056 – $127,975.
Location US‑NY‑Stony Brook – Stony Brook University Hospital.
EEO Statement Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws. If you need a disability‑related accommodation, please call the University Office of Equity and Access at (631)632‑6280.