Shift: 09:00 AM - 05:00 PM Description: Understands and adheres to the Facility Performance Standards, Policies and Behaviors Completes a comprehensive initial assessment. Performs all activities for multidisciplinary care coordination at the intra-hospital level of care and inter-hospital level of care. Performs all transitional planning activities including but not limited to: Patient/caregiver education Arrangement of all aftercare Commercial payer involvement High utilizer patient root cause Communicates and collaborates all relevant patient information to appropriate health team members. Ensures department goals of LOS reduction, readmission prevention, denial reduction, and satisfaction improvement are realized. Documents per department requirements. Participates in Performance Improvement activities as needed. Performs all UR activities per department policy: Commercial payer reviews Disposition determination, Retro/self-audit MC variance Admission clinical review. Performs all other related duties as assigned Education & Experience Requirements: BSN or related Bachelor's degree required 5 years clinical ED, critical care or med/surg experience required Previous case management experience preferred Knowledge of healthcare financial, regulatory, and payer issues preferred Knowledge of state, local, and federal programs strongly preferred Experience in use of Milliman/InterQual criteria Registered Nurse (RN) NYS license required PRI/Screen certification strongly preferred. C.C.M. (Certified Case Manager) certification preferred Computer skills essential Physical/Mental Demands/Requirements & Work Environment: May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital's SDS (Safety Data Sheet) data base and may be accessed through the hospital's Intranet site (Employee Tools/SDS Access). A copy of the SDS data base can also be found at the hospital switchboard, saved on a disc. Must be physically able to walk, stand and/or sit for extended periods of time, with the ability to carry necessary equipment (i.e. IPad or laptop) on rounds. Must be able to perform difficult manipulative, arm-hand steadiness and hand-eye coordination skills. Must be able to meet all regulatory requirements. Demonstrates ability to follow written and oral instructions required for the position. Demonstrates ability to analyze multidimensional problems into component parts and sort out tasks in priority order to solve the problem. Must be able to see object closely and far away, hear normal sounds with some background noise. Communicates effectively verbally and in writing.