Nurse Case Manager, Per Diem

Department/Unit: Care Management/Social Work Work Shift: Per Diem (United States of America) Salary Range: $71,612.39 - $110,999.20 The Case Manager is accountable to facilitate the interdisciplinary team to plan, coordinate, implement and evaluate patient care for assigned service line across the continuum of care. The Case Manager works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to achieve maximum clinical and financial outcomes. The Case Manager participates in maintaining quality care and performance improvement through leadership, problem solving, decision making, and outcome measurement. The Case Manager functions as a resource for the health care team, community, patient/significant others/family and payers by functioning as a clinician, consultant, advocate and educator for assigned service. Job Description u2022 Assists the admission MD and or designated physician and the interdisciplinary teams in assuring coordination of care across the continuum of care in the hospital pre and post-op.u2022 Proactively monitor patients' clinical process through /patient care standards and evidence-based guidelines to ensure timely, appropriate interventions that achieve optimal patient outcomes within appropriate LOS and financial constraints.u2022 Provides collaborative care management with the primary nurse in assessing for discharge planning needs, coordinating appropriate resources and evaluating effectiveness of the discharge plan. The discharge planning process needs to begin on admission.u2022 Collaborates with the health care team and appropriate department in the management of care across the continuum of care, including pre-admission, discharge, post-discharge, planning length of stay, and utilization of resources.u2022 Utilizes own special body of knowledge and evidence-based guidelines to provide leadership and guidance to the health care team in formulating an individualized multidisciplinary plan of care to include: pre-hospitalization, acute hospital care, discharge education, transition to home and use of community resources.u2022 Facilitates and participates in health care team care conference for patients with complex problems. Facilitates patient and family education and the discharge process to promote continuity of care and optimal patient outcomes.u2022 Demonstrates experience in the referral process and use of community resources.u2022 Reviews data from admission screening to clarify admission diagnosis, establish appropriate length of stay, and identify any potential outliers and determine appropriateness of admission based on institutional standards and evidence-based guidelines.u2022 Contacts payer source to confirm/negotiate benefits and provide concurrent reviews.u2022 Identifies capitated patients to determine appropriate utilization of series and coordinates post hospital care using defined standards.u2022 Identifies high-risk patients based on clinical and financial criteria for collaboration with patient financial services to problem-solve available resources.u2022 Ensures that appropriate medical/legal documentation is contained in patient's records.u2022 Complies with regulations established by third party payers including but not limited to notices of non-coverage reinstatement and continued stay.u2022 Collaborates with the health care team in implementing strategies to reduce length of stay/resource consumption to optimize patient health status for an assigned service patient.u2022 Assesses educational needs and provides learning opportunities for health care professionals relevant to particular cases and selected patient care groups.u2022 Collaborates with case management leadership to compile and report aggregate variances and data for specific patient care services.u2022 Communicates and analyzes aggregate variances with members of the health care team and develops strategies for variance reduction. Minimum Qualifications:u2022 Registered nurse with a current license.u2022 Bachelor's degree preferred but not required Thank you for your interest in Albany Medical Centeru200b Albany Medical is an equal opportunity employer. This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that: Access to information is based on a u201cneed to knowu201d and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

Created: 2025-09-26