Care Manager; RN

NYU Langone Hospital—Long Island is a 591‑bed university‑affiliated medical center offering advanced diagnostic and therapeutic care across all specialties.

We are seeking a Care Manager (RN) for a full‑time, days shift. In this role, you will coordinate post‑acute care services, ensure smooth transitions to post‑acute settings, collaborate with interdisciplinary staff, participate in quality improvement initiatives, and optimize provider reimbursement through timely insurance reviews.

• Perform an initial utilization review of patients for appropriate post‑acute care setting using industry standard criteria such as Inter Qual and Milliman Care Guidelines.
• Collaborate with attending physicians and physician advisors to review any patient not meeting criteria for the ordered level of care.
• Provide clinical reviews to payers to obtain certification of patient days and secure reimbursement; mediate concurrent denials.
• Screen all inpatients for post‑acute care needs, assess discharge needs, develop and implement a discharge plan with the patient and care team, and monitor readmissions to ensure responsiveness.
• Complete all required documentation in Allscripts, including the Patient Review Instrument (PRI) accurately and promptly.
• Identify and report risk and quality issues, track avoidable days in Allscripts, and identify improvement opportunities.
• Issue required notices (IM, discharge notice, ABN, etc.) in accordance with CMS conditions of participation and payer contracts; process Medicare Code 44 as appropriate.
• Participate in unit interdisciplinary meetings to assess patient status, facilitate communication among team members, and coordinate patient care conferences and discharge planning.

• Bachelor’s degree in Nursing (required for employees hired after 9/1/2020).
• Current and valid New York State Registered Nurse license.
• BLS certification issued by the American Heart Association.
• 3–5 years clinical acute‑care experience.
• Excellent oral and written communication, interpersonal, and organizational skills.
• Knowledge of clinical standards of practice for multiple patient populations and basic computer skills.

• Bachelor’s degree in Nursing.
• Experience with the New York State Department of Health Patient Review Instrument (PRI) assessment.
• 3–5 years in discharge planning or utilization management.
• Knowledge of post‑acute care referral processes and hospital reimbursement, insurance denials, and appeals.

NYU Langone Hospital—Long Island is an equal‑opportunity employer committed to inclusion. All qualified individuals are encouraged to apply.

Salary Range: $ – $ annually. The range does not include bonuses, incentive pay, or other compensatory benefits.