RN/Case Manager-MSH-Case Management-FT-Days
Join to apply for the RN/Case Manager-MSH-Case Management-FT-Days role at Mount Sinai Health System
Responsibilities
Review all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve optimal patient outcomes and appropriate reimbursement for the organization.
Perform continued stay reviews utilizing standardized criteria to justify continued inpatient stay.
Collaborate with Physician and other clinicians to expedite diagnostic testing, treatment and consultations.
Document all clinical reviews in Case Management Documentation system.
Support the mission, vision, philosophy and goals of the Medical Center.
Assessment of the patient’s clinical, psychosocial, and functional status in collaboration with the interdisciplinary team.
Identification and documentation of variances affecting the LOS and the discharge planning process.
Conduct follow-up of any delays in treatment or reporting of results.
Planning/developing specific goals with the physician, interdisciplinary team, and the patient and/or family.
Implementation and coordination of specific activities, strategies, and interventions to move the patient through the continuum of care.
Documentation of outcomes achieved and identified internal and external barriers.
Identify reasons for readmissions and collaborate with interdisciplinary team on strategies to reduce readmission rate.
Appropriately identify and refer cases to the physician advisor to support timely progression of patients along the continuum of care and (appropriate) discharge planning.
Interact with patient/family to discuss plan of care and coordination of services based on clinical needs and available resources.
Maintain a working knowledge of the UR (Utilization Review) requirements of each payor within the patient population.
Provide the clinical information requested by the managed care companies as part of the concurrent review in a timely fashion.
Work collaboratively with physicians and managed care companies on concurrent denial appeals.
Communicate clinical information to the payor, as needed, coordinating direct communication between physician and payor Medical Director as required.
In psychiatry, the CM will document UR notes in the medical record as per OMH guidelines.
Responsible for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission).
Obtain authorizations from managed care companies for post-discharge services.
Assess for clinical readiness and complete the Hospital and Community Patient Review Instrument (PRI) for patients requiring Residential Health Care Facility placement.
Liaison with financial department for current insurance coverage.
Collaborate and participate in the appeals process with all members of the interdisciplinary team.
Develop and maintain effective working relationships with interdisciplinary team and Case Managers within the managed care organizations.
Participate in nursing orientation.
Interface with other departments in the Medical Center.
Qualifications
Education Requirements
Bachelors Degree in Nursing; Masters preferred.
Experience Requirements
Previous experience as in homecare, long term care or utilization review preferred.
Discharge Planner or Case Manager preferred.
Manager or a minimum of 3-5 years experience as a RN in an acute care setting.
Licensing And Certification Requirements
Current NYS RN nursing license.
CCM certification preferred. Re-credentialing of CCM status expected.
PRI Certification (to be obtained within 1 year)
Name: Basic Life Saver (BLS) Issuing Agency: AHA
Collective bargaining unit: NYSNA-MSH
NYSNA at Mount Sinai Hospital , 329 - Case Management - MSH, Mount Sinai Hospital
Employer Description
Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai’s unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual. At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history.
Equal Opportunity Employer
The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.
Compensation
The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $63.28 - $63.28 Hourly. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.