Nurse Case Manager - Full Time, DAYS
Company: Albany Medical Center
Location: Ghent
Posted on: June 24, 2025
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Job Description:
Ghent, NY, United States Department/Unit: Care Management/Social
Work Work Shift: Day (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, Social
Work, 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.
Principal Position Responsibilities 1. Coordination of Care a.
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. b. 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. c. 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. d. 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. e. 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. f. Facilitates and participates in health care team care
conference for patients with complex problems. g. Facilitates
patient and family education and the discharge process to promote
continuity of care and optimal patient outcomes. h. Demonstrates
experience in the referral process and use of community resources.
2. Utilization Review a. 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. b. Contacts payer source to confirm/negotiate benefits
and provide concurrent reviews. c. Identifies capitated patients to
determine appropriate utilization of series and coordinates post
hospital care using defined standards. d. Identifies high-risk
patients based on clinical and financial criteria for collaboration
with patient financial services to problem-solve available
resources. e. Ensures that appropriate medical/legal documentation
is contained in patient's records. f. Complies with regulations
established by third party payers including but not limited to
notices of non-coverage reinstatement and continued stay. g.
Follows department UM guidelines. 3. Quality Improvement a.
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. b. Assesses
educational needs and provides learning opportunities for health
care professionals relevant to particular cases and selected
patient care groups. c. Demonstrates creativity and critical
thinking ability in the development of programs or projects. d.
Works with quality improvement team for continuous improvement of
patient care outcomes while increasing quality and decreasing cost.
e. Ensure that communication and transmission of documentation
occurs with community agencies. 4. Measurement a. Collaborates with
case management leadership to compile and report aggregate
variances and data for specific patient care services. b.
Communicates and analyzes aggregate variances with members of the
health care team and develops strategies for variance reduction.
Qualifications and Ideal Characteristics 1. Registered nurse with a
current license. 2. Bachelor's degree required preferred Master’s
degree preferred. 3. Minimum of three years clinical experience in
an assigned service. Acute care nursing experience preferred. 4.
Recent experience in case management, utilization management and/or
discharge planning/home care in a high volume, acute care hospital
preferred. PRI and Case Management certification preferred. 5.
Demonstrates effective communication, facilitation, and
organizational skills. 6. Assertive and creative in problem
solving, critical thinking skills, systems planning and patient
care management. 7. Self-directed with the ability to adapt in a
changing environment. 8. Basic knowledge of computer systems with
skills applicable to utilization review process. Mission, Core
Values and Service Excellence 1. Contributes to the creation of a
compassionate and caring environment for patients, families, and
colleagues through displays of kindness and active listening.
Recognizes and appreciates that each employee’s work is valuable
and contributes to the success of the Mission. 2. Demonstrates
excellence in daily work. Willing to actively participate in
performance and quality improvement activities and to work towards
enhancing customer/patient satisfaction. 3. Exhibits positive
service excellence skills to patients, visitors, and coworkers by
greeting others in a friendly manner, keeping
customers/patients/colleagues informed about progress, delays, and
changes. 4. Demonstrates effective teamwork by interacting in a
positive manner with colleagues and creating a collaborative work
environment. Initiates open communication, conveys positive intent,
offers assistance. 5. Contributes to a safe and secure environment
for patients, visitors, colleagues by following established
procedures and protocols. 6. Demonstrates stewardship by thoughtful
and responsible use of resources including maintaining a clean and
hospitable environment, starting work on time, displaying a
consciousness regarding costs, supplies and department finances. 7.
Demonstrates respect for individual differences of each person by
acknowledging the essence of each person, appreciating, and
responding to unique, spiritual, personal, and cultural backgrounds
of patients, families, and colleagues. Physical Demands The
physical demands described here are representative of those that
must be met by an employee to successfully perform the essential
functions of this job. While performing the duties of this job, the
employee is regularly required to stand, walk, use hands to probe,
handle, or feel objects, tools, or controls, reach with hands and
arms, and speak and hear. The employee is occasionally required to
sit and stoop, kneel, or crouch. The employee must regularly lift
and/or move up to 50 pounds. Specific vision abilities required by
this job include close vision, distance vision, peripheral vision,
depth perception, and the ability to adjust focus. Work Environment
The work environment characteristics described here are
representative of those an employee encounters while performing the
essential functions of this job. While performing the duties of
this job, the employee may be subject to infectious materials and
chemicals (see unit specific MSDS information). The noise level in
the work environment is usually moderate. This job requires as an
essential function that the majority of the time the employee be
physically on-site as the work cannot be done from a remote
location. Other Requirements All job requirements listed indicate
the minimum level of knowledge, skills, and/or ability deemed
necessary to perform the job proficiently. This job description is
not to be construed as an exhaustive statement of duties,
responsibilities, or requirements. Employees will be required to
perform any other job-related instructions given by their su Thank
you for your interest in Albany Medical Center!? 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 “need
to know” 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.
Keywords: Albany Medical Center, Leominster , Nurse Case Manager - Full Time, DAYS, Healthcare , Ghent, Massachusetts
