Travel Nurse RN - Case Manager In White Plains, NY

Job Title: Registered Nurse (RN) Job Specialty: Case Management (Utilization Review) Job Duration: 8 weeks Shift: 10-hour Days: 8 AM - 6 PM Guaranteed Hours: 38 hours per week Experience: Minimum 2 years required; 3 years of clinical ED, critical care, or med/surg experience preferred License: NYS RN license required Certifications: BLS, COVID Vaccine Required Must-Have: - Discharge experience

• COVID Vaccine

• PRI Certification (to be obtained within 3 months of initial employment)

• Strong preference for screen certification

• Care Management certification preferred (e.g., CMC, CCM) - Experience with Milliman/InterQual criteria

• Strong computer skills

• Knowledge of healthcare financial, regulatory, and payer issues

• Familiarity with state, local, and federal programs Job Description:

• Conducts comprehensive initial assessments on admission, using established tools for high-risk indicators.

• Provides ongoing reassessment of needs throughout the hospital course.

• Manages all activities for multidisciplinary care coordination within and between hospital levels of care.

• Performs transitional planning activities, including patient/caregiver education, arrangement of aftercare, commercial payer involvement, and addressing high utilizer patient root causes.

• Communicates patient information effectively to relevant health team members.

• Works towards achieving department goals: length of stay reduction, readmission prevention, denial reduction, and satisfaction improvement.

• Participates in Performance Improvement activities as needed.

• Conducts Utilization Review activities per department policy: commercial payer reviews, disposition determination, retro/self-audit, medical necessity variance, and admission clinical review.

• Collaborates with healthcare professionals to ensure safe discharge planning for all patients, including geriatric patients in various hospital settings.

• Performs any other related duties as assigned. .Charting System: Epic.