Cmc Program Manager Jobs in Paramus, NJ (NOW HIRING)

Medical Solutions Direct Hire is seeking a Registered Nurse (RN) Care Manager for a nursing job in Valhalla, New York.

• Specialty: Care Manager
• Discipline: RN
• Duration: Ongoing
• 37.5 hours per week
• Shift: 8 hours, days
• Employment Type: Staff

DIRECT HIRE

RN CARE MANAGER

Salary Range: $124,156 – $158,065

• 1–3 years of clinical nursing experience preferred, particularly in Emergency Department, Critical Care, or Medical-Surgical settings.
• 1–3 years of previous Case Management experience preferred.
• Experience utilizing Milliman/InterQual criteria preferred.
• Knowledge of healthcare financial, regulatory, and payer issues preferred.
• Knowledge of state, local, and federal healthcare programs strongly preferred.
• Strong computer skills required.

• BSN required or MSN.

• Current Registered Nurse (RN) license – New York State required upon hire.
• PRI (Patient Review Instrument) Certification required within 90 days.
• NYS SCREEN Certification strongly preferred.
• Care Management certification preferred, such as CCM or CMC.

DOCUMENTS REQUIRED FOR SUBMISSION OR PLACEMENT

• Proof of BSN or MSN degree.
• Proof of active New York State RN licensure.
• PRI Certification, if already obtained.
• NYS SCREEN Certification, if already obtained.
• CCM/CMC or other Care Management certification, if applicable.
• Proof of flu vaccine — required, no exceptions.

JOB DESCRIPTION

The RN Care Manager collaborates with healthcare professionals across the continuum of care to assess patient needs, coordinate multidisciplinary services, facilitate safe and appropriate discharge planning, and support quality and operational outcomes. The role serves geriatric patients across inpatient, emergency department, and surgical outpatient settings while supporting length-of-stay reduction, readmission prevention, denial reduction, and patient satisfaction.

• Complete comprehensive initial patient assessments.
• Perform multidisciplinary care coordination at both the intra-hospital and inter-hospital levels of care.
• Coordinate transitional planning, including:
  • Patient and caregiver education.
  • Arrangement of appropriate after-care services.
  • Commercial payer involvement.
  • Root-cause assessment for high-utilizer patients.
• Communicate and collaborate with appropriate healthcare team members regarding relevant patient information.
• Support department goals related to:
  • Length-of-stay reduction.
  • Readmission prevention.
  • Denial reduction.
  • Patient satisfaction improvement.
• Complete required clinical and departmental documentation.
• Participate in Performance Improvement activities as needed.
• Perform utilization review activities in accordance with department policy, including:
  • Commercial payer reviews.
  • Disposition determination.
  • Retro/self-audits.
  • Managed care variance review.
  • Admission clinical review.
• Collaborate with physicians, nurses, social workers, and other healthcare professionals to evaluate patient needs and facilitate safe discharge.
• Support care management for geriatric patients across inpatient, emergency department, and surgical outpatient settings.
• Understand and adhere to WPH Performance Standards, Policies, and Behaviors.
• Perform other related duties as assigned.

• Monday–Friday: 9:00 AM–5:00 PM
• Shift: Days
• Shift Length: 8 hours
• Alternating weekends and holidays

MARKET INFORMATION

Salary Low: $124,156
Salary High: $158,065

-BSN Required or MSN -1-3 years 3 years Clinical experience-ED, Critical Care, or Medical Surgical nursing preferred Preferred -1-3 years Previous Case Management experience preferred Preferred -1-3 years Experience in the use of Milliman/InterQual criteria Preferred -Knowledge of healthcare financial, regulatory, and payer issues preferred -Knowledge of state, local, and federal programs strongly preferred -Computer skills essential -Registered Nurse New York - New York State Board of Nursing Upon Hire Required -PRI - Patient Review Instrument Cert - PHTC PRI Certification within 90 Days Required SCREEN - New York State Dept of Health PRI Screen Strongly preferred Preferred -CCM - Certified Case Manager - Commission for Case Manager Certification A Care -Management certification is preferred (i.e., CCM, CMC) CMC Preferred