Rochester Regional Health Systems

Care Manager-RN

Hospitals & Medical Centers
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • Diploma or Associate's Degree in Nursing required
  • Registered Nurse license in New York State
  • Basic Life Support (BLS) certification required
  • Three years of acute hospital care, case management, or utilization management experience preferred
  • Strong organizational skills and problem-solving abilities
  • Knowledge of federal and state regulations (DOH, Medicaid/Medicare)

Responsibilities

  • Evaluate hospital admissions for medical necessity and appropriate care levels
  • Collaborate with healthcare teams to enable safe and effective discharge plans
  • Coordinate the development and implementation of clinical pathways and guidelines
  • Participate in compliance with care guidelines and core measures
  • Communicate with third-party payors to ensure reimbursement for services

Benefits

  • Collaborative work environment focused on quality patient care
  • Strong support for professional development and compliance improvement
  • Opportunity to influence care processes and outcomes
  • Engagement with diverse healthcare teams to address patient needs
  • Regular assessment of hospital resources to enhance patient management
Full Job Description
Job Title: Registered Nurse - Care Manager

Department: Care Management

Location: Rochester General Hospital

Hours Per Week: 40 Hours

Schedule: Day

SUMMARY:

As a Registered Nurse - Care Manager, your excellent interpersonal, leadership and collaboration skills ensure the appropriate allocation of hospital resources while maintaining the quality of care.

RESPONSIBILITIES:
  • Evaluation & Review. Evaluate hospital admissions to assure care is medically necessary and delivered at the most appropriate level; actively participate in the concurrent review process and communicate/intervene with third party payors to ensure reimbursement for services are provided while maintaining quality of care
  • Patient Management. Collaborate with providers, patients and families to address concerns and identify safe, effective discharge plans; intervene to identify and facilitate early referral for discharge planning; facilitate the discharge process by working with the healthcare team to identify alternative solutions to minimize system delays while ensuring a safe discharge plan
  • Recommendation. Coordinate and participate in the development, implementation and revisions of evidence based clinical pathways and guidelines; participate in driving clinical and administrative compliance with care guidelines and core measures; identify and recommend actions for improvement


ATTRIBUTES
  • Three (3) years of acute hospital care, case management or utilization management experience preferred
  • Excellent oral and written communication and interpersonal skills
  • Good understanding of medical management techniques and processes
  • Knowledge of federal and state regulations (DOH, Medicaid/Medicare)
  • Strong organizational and problem-solving skills
  • Knowledge of third party payor and/or managed care payment principles helpful


REQUIRED QUALIFICATIONS:
  • Diploma or Associate's Degree in Nursing
  • Registered Nurse license in New York State.
  • Basic Life Support (BLS) certification.


PREFERRED QUALIFICATIONS:
  • Bachelor's Degree in Nursing preferred.
  • At least 6 months RN experience preferred


EDUCATION:

LICENSES / CERTIFICATIONS:
BLS - Basic Life Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education Department (NYSED)New York State Education Department (NYSED)

PHYSICAL REQUIREMENTS:
M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects; Requires frequent walking, standing or squatting.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.

PAY RANGE:
$82,742.00 - $113,568.00

CITY:

Rochester

POSTAL CODE:

14621

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

About Rochester Regional Health Systems

Rochester Regional Health is a health care system based in Rochester, New York. The system was formed in 2014 through the merger of Rochester General Health System and Unity Health System. Rochester Regional Health provides a wide range of health care services, including primary care, specialty care, and hospital services. The system operates five hospitals and numerous outpatient clinics and physician practices. Rochester Regional Health is committed to providing high-quality, patient-centered care and has been recognized for its clinical excellence and patient satisfaction.
Learn more about Rochester Regional Health Systems
Size
18,000 employees
Industry

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