Insurance Nurse Case Manager Jobs (NOW HIRING)

Blythedale Children’s Hospital is an independent children’s specialty hospital in New York State. Our multidisciplinary team provides critical care to patients with complex medical conditions. We partner with academic medical centers in the Northeast Corridor of the United States to admit patients to our state-of-the-art 118-bed facility. Our experts integrate clinical expertise and health education in our on-site simulation rooms to provide extensive parent training to get our patients home safely. Learn more about Blythedale on our website here.

The Nurse Case Manager organizes all necessary healthcare services to promote child-centered and family-centered outcomes that will facilitate the highest possible quality of life for each patient. The Nurse Case Manager is responsible for facilitating and coordinating the clinical, financial and psychosocial aspects of admission and discharge; planning for patients admitted to Blythedale’s inpatient service and residents admitted to the Steven and Alexandra Cohen Long Term Care Pavilion (LTC).

Through collaboration with the referring hospital, medical care team, social worker, patient/family educators, therapists, and other disciplines, they ensure timely and accurate transfer of information from the referring hospital to the care team and prepare for all aspects of the safe admission and discharge of patients. They are responsible for addressing the holistic needs of the patient or resident including medical support, education, caregiver training, ongoing rehabilitation, equipment, and behavioral health support.

The Nurse Case Manager is the first point of contact for patients and their families following referral to Blythedale. They will participate in family tours and help set family expectations when transitioning from acute care. They continue to support them with planning and preparing for discharge.

The Nurse Case Manager makes referrals to homecare agencies, DME suppliers, outpatient therapy sites, health homes, and long-term care facilities as recommended by the treatment team and in consultation with the family.

Services are determined by patient/resident/family choice and the Nurse Case Manager will provide support in understanding what is possible under the patient/resident’s insurance(s) and in their geographic area. They will collaborate with the patient/resident’s providers as necessary to support continued stay or advocate for discharge needs.

• Collaborates and coordinates with the healthcare team regarding the patient/resident’s plan for admission and
• Facilitates the smooth transition from referring hospital to Blythedale, ensuring that all necessary clinical, financial and psychosocial information has been analyzed and shared with the team to assess the need for additional information.
• Based on the assessed needs of the individual, refers the child and family to agencies that provide needed medical services to facilitate a smooth discharge.
• Works closely with the patient, residents, and family throughout the admission and discharge planning process to best understand their needs while providing education about the availability and scope of potential
• Facilitates exchange of information with insurers regarding continued stay and discharge service
• Elevates discharge-related situations or factors that may contribute to an extended length of
• Completes PRIs and SCREENs for patients or residents when
• Ensures that resource lists for families are up to date with current contact information to promote informed choice of service providers.
• Maintains relationships with outside vendors and alerts Director and/or designee of any issues or concerns with their quality of care.
• Attends unit meetings and parent conferences to collaborate with the team and family around anticipated discharge needs.
• Performs other functions at the discretion of the Director and/or designee.

• 3+ years of experience as an RN case manager.
• Experience in a pediatric setting required.
• Experience with Meditech is preferred.
• Proficiency in Microsoft Office Suite (Outlook, Word, Excel, PPTX, Teams), Adobe Acrobat required.
• Bilingual in English and Spanish preferred.

• Active New York State Registered Nurse licensure required.
• Bachelor of Science in Nursing from an accredited institution in the US required.
• PRI and Screen Certification preferred.

• Standing, walking, stooping. 
• Ability to engage with patients/residents on their unit.
• Ability to meet flexible scheduling demands and patient care needs.

• Competitive Salary: We offer a salary that reflects your skills and experience.
• Professional Development Opportunities: Access to mentorship, leadership training, and career advancement programs.
• Comprehensive Health Benefits: Including medical, dental, and vision benefits for you and your family. 
• Retirement Plans with Employer Matching: Secure your future with our strong retirement plans.
• Paid Time Off (PTO): Generous vacation, holiday, and sick leave policies.
• Safe Work Environment: Commitment to everyone’s safety and well-being.
• Diversity and Inclusion Initiatives: A workplace that values and supports all employees.

Blythedale Children's Hospital is an Equal Opportunity Employer (EOE).