Care Manager RN – Full Time, Days

Job ID: 1138711_RR00101135

Facility: NYU Langone Hospital—Suffolk

Position Type: Full-Time/Regular

Shift: Day

Schedule: Monday – Friday 08:00 AM – 04:00 PM with one weekend a month

Department: Nursing, Care Management (E7760)NYU Langone Hospital—Suffolk

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Healthcare staff navigate the vibrant, bustling lobby of the Kimmel Pavilion at NYU Langone Health during a typical workday.

NYU Langone Hospital—Suffolk is a 306-bed medical center, providing care to residents of eastern Long Island. The hospital facility is home to the Knapp Cardiac Care Center—an advanced heart disease diagnostic and treatment facility—as well as a modern ambulatory surgical pavilion with specialized services including women’s imaging, a sleep laboratory, and bariatric surgery. Our Provisional Level 2 Trauma Center delivers comprehensive and specialized care for patients with traumatic injuries. The Stroke Center at NYU Langone Hospital—Suffolk is designated by the New York State Department of Health as a Primary Stroke Center, with expert neurologists available to provide treatment 24 hours a day, 7 days a week. Additionally, NYU Langone Hospital—Suffolk has multiple outpatient sites, including an outpatient wound care center, a hemodialysis center, and various primary care and specialty offices.For more information, go to NYU Langone Hospital—Suffolk , and interact with us on LinkedIn, Glassdoor, Indeed, Facebook, Twitter, YouTube, and Instagram.

Position Summary:
We have an exciting opportunity to join our team as a Care Manager RN – Full Time, Days – Care Management – Full-Time – 08:00 AM – 04:00 PM.  
 
The RN Care Manager collaborates with the interdisciplinary team to implement the plan of care and transition strategies ensuring the achievement of desirable patient outcomes appropriate length of stay efficient utilization of resources increased patient and family involvement and patient/staff/family education Implementation is accomplished through patient assessment monitoring of the plan of care review activities coordination with the interdisciplinary team and any outside third party payers communicating with physicians performing utilization management activities to avoid denials reduce avoidable delays and control costs where possible and by facilitating continuity of care across settings
 
Job Responsibilities:
 
Utilization Management
 
  Demonstrates accountability for utilization management functions and communication with payers to assure authorization and payment for hospital stay.
  Performs admission review within 24 hours of admission on all patients in case load utilizing InterQual Criteria to determine if patient meets medical necessity for admission.
  Initiates contact with attending physician to solicit additional information to support medical necessity for admission when there is not adequate information in the medical record.
  Suggests alternative level of care/treatment plan for patients not meeting medical necessity for admission.
  Refers cases for second level review that do not meet medical necessity or level of care requirements, according to department procedure.
  Documents review in Soft Med according to department procedure.
  Submits reviews to third party payors according to contract requirements in a timely manner.
  Assures days are approved and information is entered in Soft Med in a timely manner.
  Follows up with third party payors when there is a lack of response to request for authorization.
  Advocates for the patient, family, physician, and facility to obtain benefits from third party payors and others that provide financial assistance.
  Communicates with patients and families to ensure understanding of third-party payor guidelines.
  Conducts continued stay review as indicated based on clinical condition and third party payor requirements.
  Collaboratively institutes prevention plans to avoid third party payor denials and problems solves with the health care team when denials are received.
  Manages concurrent denial/appeal process in collaboration with the UR Specialist.
  On a concurrent basis, assesses the appropriateness and timeliness of the level of care, diagnostic testing and clinical procedures, quality and clinical risk issues, and documentation completeness.
  Issues denial letters as indicated according to department procedure.
  Acts collaboratively to resolve resource issues, keeping manager/director informed as needed.
  Refers cases with complex psychosocial and medical issues to the social worker according to department guidelines.
  Communicates with the attending physician to clarify information regarding the plan of care as needed.
  Escalates cases not meeting continued stay criteria or when an alternative level of care is more appropriate when barriers to care progression are unresolved, according to department procedure.
 
Discharge Planning
 
  Leads and implements the transition planning process from the time of admission to discharge by effectively assessing patient/family needs, preferences, and available resources.          
  Completes a discharge planning assessment for all patients in assigned case load within 24 hours of admission.
  Confers with attending physician and other members of the health care team to identify needs.
   Documents all pertinent information in the electronic medical record.
  Serves as a resource and advocate for patients/families by providing information regarding available resources appropriate for the patient’s discharge plan and third party payer guidelines.
  Communicates with patient/family to ensure understanding of anticipated discharge date and involvement in planning for care after discharge in a consistent and timely manner.
  Refers cases with complex psychosocial and or medical issues that may create barriers to discharge to the social worker according to department guidelines.
  Completes the PRI in a timely manner as indicated.
  Initiates referral to facilities and agencies that can meet the post hospital care needs of the patient and are authorized by third party payors.
  Ensures patients’ right to choice in providers of post hospital care by providing a list of agencies and facilities that can meet the patient’s care needs.
  Ensures continuity of care by acting as a liaison between the hospital and community resources.
  Provides all required information to the agency/facility to facilitate a smooth transition.
  Maintains positive working relationships with community agencies and facility staff to maximize access for patients/families.
  Keeps up to date on available community resources and regulatory requirements that impact discharge planning.
  Provides input to the development of processes that improve continuity, transitions, and patient centered care across the continuum of care.
 
Care Progression
 
Identifies anticipated discharge date at the time of admission in collaboration with the members of the health care team.
 Ensures that the patient/family is aware of the plan of care and anticipated length of stay.
Monitors patient’s plan of care and progress in relation to anticipated length of stay and intervenes to facilitate a timely discharge.
Attends daily Patient Care Progression Rounds and follows up on any issues/barriers identified with the appropriate staff/departments.
Facilitates communication among team members to resolve issues that may impact the plan of care.
Encourages interventions appropriate to the reason for the patient’s admission.
Initiates referrals to the appropriate areas to expedite care, treatment, and services ( SW,PT, speech therapy, financial counselor, palliative care, etc.)
Seeks input from clinical experts to explore acceptable alternatives to treatment plan.
Identifies and documents avoidable delays in care and works collaboratively the healthcare team to prevent them.
Escalates cases with unresolved issues according to department guidelines.
 
Minimum Qualifications:
To qualify you must have a Current NYS Registered Nursing License B S or M S preferred Case Management certification from accepting accrediting body preferred Minimum 5 years of clinical medical surgical experience and 3 5 years experience as a hospital in patient Case manager Must possess knowledge of Federal and State regulations pertaining to hospital reimbursement the utilization review process and the discharge planning function. Knowledge of identification assessment and intervention pertaining to high risk populations Working knowledge of/completion of CDI Clinical Documentation Implementation Training Working knowledge/experience with hospital/care management software documenting electronically and compiling data from the electronic medical record. Working knowledge of Microsoft outlook Microsoft Word Excel Powerpoint and scanning PRI and Screen certifications preferred. 
 
Required Licenses: Registered Nurse License-NYS

Qualified candidates must be able to effectively communicate with all levels of the organization.

NYU Langone Hospital—Suffolk provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you’ll feel good about devoting your time and your talents.

 

NYU Langone Hospital—Suffolk is an equal opportunity employer and committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration. We require applications to be completed online.

 

View NYU Langone Hospital—Suffolk’s Equal Employment Opportunity (EEO) policy. Know Your Rights: Workplace discrimination is illegal.

 

NYU Langone Hospital—Suffolk provides a salary range to comply with the New York state Law on Salary Transparency in Job Advertisements. The salary range for the role is $110,353.08 – 143,335.48 Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

View the Pay Transparency Notice for further details.

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Salaries shown on independent jobs related websites reflect market averages and do not represent information obtained directly from NYU Langone. We invite and encourage each candidate to discuss salary/hourly specifics during the application and hiring process.

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About NYU Langone Health

Be Where Everyone Is Dedicated to Exceptional Care

NYU Langone is a world-class, patient-centered, integrated academic health system with Magnet®-recognized status by the American Nurses Credentialing Center (ANCC). Our trifold mission to care, teach, and discover is achieved daily through NYU Langone’s diverse and inclusive culture devoted to excellence across the organization. Here, you can advance your career supported by exceptionally talented faculty and staff in an environment where everyone works together to deliver the best possible outcomes for our patients.

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Our Hiring Process

Joining Our Team

Get ready to start your career journey at NYU Langone, where cutting-edge research meets compassionate care, and discover how you can contribute to shaping the future of medicine.

Step 1

Apply Online

The NYU Langone hiring process begins with you applying through our online portal. Be sure to update and upload your resume. Shortly after you submit your application, you will receive an email confirmation. Ten days after applying you will receive a talent assessment to be completed.

Step 2

Schedule Interviews

If selected to continue the interview process, HR will reach out via phone or email first. Then, depending on your position, they will schedule an interview with unit managers or team members. You are encouraged to dress professionally for all interviews.

Step 3

Receive Offer

If you successfully complete the interview process and are identified as a finalist for the position, we will require that you complete a professional reference process. After evaluating the completed references, a decision will be made on who will receive a preliminary offer. If you receive a preliminary offer, HR will start the onboarding process with an agreed-upon tentative start date.

Step 4

Training & Orientation

You will be contacted by an onboarding specialist who will work with you on your pre-boarding requirements. Once fully cleared, we will ask you to complete compliance orientation regulatory training. On your first day, you will attend an online required orientation to acclimate to the health system and report to your new department based on instructions provided by your hiring manager.

Our Awards Reflect a Commitment to Excellence at Every Level

Best Hospitals Honor Roll 2024–2025. U.S. News & World Report
America’s Most Admired Workplaces. Newsweek Plant-A Insights Group 2025
America's Greatest Workplaces 2024. Newsweek Plant-A Insights Group
Magnet Recognized. American Nurses Credentialing Center
Business Group on Health. Best Employers: Excellence in Mental Health 2024
Business Group on Health. Best Employers: Excellence in Health & Well-being 2024
Forbes 2019-2024 America’s Best-In-State Employers Powered by Statista. All Time Champion
Ragan Workplace Wellness Awards Winner
America's Greatest Workplaces for Mental Wellbeing 2024. Newsweek Plant-A Insights Group
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American Society of Transplantation. AST Living Donor Circle of Excellence

Hear From Our Team

  • Joseph O.

    Refrigeration Engineer Helper

    In my role, I provide a favorable atmosphere for our patients, visitors, employees, and students by ensuring their safety against fire hazards and by maintaining conducive temperatures throughout the seasons. I'm proud to work alongside my teammates to provide excellent service at a world-class organization that offers great opportunities to deserving candidates.

    Jan 2018
    Security Officer
    Nov 2022
    Refrigeration Engineer Helper

  • Jane F.

    Dental Assistant

    NYU Langone Health is a great place to work. I enjoy working with my colleagues as a team. NYU Langone offers training programs that allow us to grow within the organization. I feel valued as 
an employee.

    Feb 2009
    Senior Nursing Assistant –
    Stroke Unit
    MAR 2022
    Dental Assistant Trainee
    FEB 2023
    Dental Assistant

  • Noa L.

    Supervisor, Patient Access Center

    When I first began working at NYU Langone Health, I felt a sense of belonging and realized this is where I want to spend the rest of my professional career. Since joining, I've pushed myself to do well in every position I have and to advance. I not only enjoy my current role, but I also enjoy learning about new topics. I am excited to explore what else NYU Langone has to offer me in my career.

    Nov 2021
    Access Center Representative I
    Aug 2022
    Access Center Representative II
    Oct 2023
    Lead Access Center Representative
    Sept 2024
    Supervisor, Patient Access Center

  • Victoria L.

    Senior Social Worker

    Growing up in New York City, I was aware of the prestige that NYU Langone Health held, so I decided to pursue a career at the premier health system after graduation. I enjoy helping, treating and supporting everyday New Yorkers and feeling like I make a difference. Working here, I feel like I am able to show up as my authentic self to assist our patient community.

    Nov 2016
    Social Worker
    Jul 2022
    Senior Social Worker

  • I was fortunate to receive firsthand training from some of the founding team members of my department. This made my onboarding experience invaluable, and now I will get to pass on my knowledge and experience to future new hires within the department and pay it forward. The collaborative spirit at NYU Langone Health has created an excellent work culture where I can work alongside colleagues who share our same company vision to serve, teach and discover.

    Nazneen H.

    Clinical Charge Nurse Auditor in Revenue Management Initiatives  

Frequently Asked Questions

We offer different employment options to fit every schedule and talent area of interest. These options include full time, part time, per diem, internship, and temporary.

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Paid internship opportunities can be found on our careers site by searching via the Job Search function. Unpaid internships are organized by department. You can explore our departments at NYU Langone to find an internship opportunity that suits your educational endeavors. Additionally, please visit the internship page to learn more about our internship opportunities.

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