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About the Role

The Case Manager (CM) will be responsible for all aspects of case management for an assigned group of inpatients to determine the appropriateness of the admission and continued stay, assist in the development of the plan of care, ensure the plan is implemented in a timely basis, and identify the expected length of stay (ELOS). The CM works collaboratively with physicians, social workers, clinical nurses, home care services, and other members of the interdisciplinary team. The CM actively participates in specific clinical initiatives focused on reducing length of stay (LOS), improving efficiency, quality, and resource utilization.

Responsibilities

Reviews all new admissions to identify patients needing utilization review, discharge planning, and/or case management using standardized criteria.
Performs continued stay reviews using standardized criteria to justify continued inpatient stay.
Collaborates with physicians and other clinicians to expedite diagnostic testing, treatment, and consultations.
Documents all clinical reviews in Canopy.
Supports the mission, vision, philosophy, and goals of the Medical Center.
Assesses the patient’s clinical, psychosocial, and functional status in collaboration with the interdisciplinary team.
Identifies and documents variances affecting LOS and the discharge planning process.
Conducts follow-up of any delays in treatment or reporting of results.
Plans and develops specific goals with the physician, interdisciplinary team, and the patient/family.
Implements and coordinates specific activities, strategies, and interventions to move the patient through the continuum of care.
Documents outcomes achieved and identified internal and external barriers.
Identifies reasons for readmissions and collaborates with the interdisciplinary team on strategies to reduce readmission rates.
Identifies and refers cases to the physician advisor to support timely progression of patients and appropriate discharge planning.
Interacts with patient/family to discuss the plan of care and coordination of services based on clinical needs and available resources.
Maintains a working knowledge of the UR requirements of each payor.
Provides clinical information requested by managed care companies for concurrent review in a timely fashion.
Provides clinical information requested by managed care companies in accordance with contractual agreements.
Works collaboratively with physicians and managed care companies on concurrent denial appeals.
Communicates clinical information to the payor, coordinating direct communication between physician and payor Medical Director as required.
Documents UR notes in the medical record as per OMH guidelines in psychiatry.
Assesses, communicates, and monitors the discharge planning process.
Obtains authorizations from managed care companies for post-discharge services.
Assesses for clinical readiness and completes the Hospital and Community Patient Review Instrument (PRI) for patients requiring Residential Health Care Facility placement.
Liaises with the financial department for current insurance coverage.
Collaborates and participates in the appeals process with all members of the interdisciplinary team.
Develops and maintains effective working relationships with the interdisciplinary team and Case Managers within managed care organizations.
Participates in nursing orientation.
Interfaces with other departments in the Medical Center.

Requirements

Bachelor’s Degree in Nursing
Previous experience in homecare, long term care, or utilization review preferred.
Discharge Planner or Case Manager experience preferred.
Manager or a minimum of 3-5 years’ experience as an RN in an acute care setting.
Current NYS RN nursing license.
CCM certification preferred.
PRI Certification (to be obtained within 1 year).

Skills

Case Management
Utilization Review
Discharge Planning
Interdisciplinary Team Collaboration
Clinical Documentation
Patient Assessment
Care Planning
Resource Utilization
Managed Care
Appeals Process
Communication

Location

New York

Work Type

Full-time

Experience Level

3-5 years RN experience in acute care
Manager experience

Education Level

Bachelor's Degree in Nursing
Master's preferred

Salary/Compensations

$66.1277 Hourly

About the Company

The 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.
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education.
Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment.
The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers.
We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology.
New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology.
U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children’s Hospital among the country’s best in several pediatric specialties.
The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges.
Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.

Equal Opportunity

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.