🌟 Care Management Representative 📍 Location: Saratoga Hospital, 211 Church Street, Saratoga Springs, NY 12866 🕒 Employment Type: Full Time 📌 Shift/Schedule: Day Shift 💡 About Saratoga Hospital At Saratoga Hospital, we’ve built a reputation for high-quality, compassionate care and a commitment to the health and well-being of our community. As part of the Albany Med Health System, we combine advanced technology with a deeply personal approach—creating a supportive environment for patients, staff, and providers alike. We believe that exceptional care starts with exceptional people. 🎯 About the Role + This Care Manager Representative position is responsible for providing care coordination, comprehensive discharge planning, daily rounding with interdisciplinary team, utilization review/management, readmission avoidance action plan strategies, care transitions coordination and strategic plans for the Collaborative Practice Groups under the guidance of the Director of Care Management. The Care Management Representative participates in a collaborative process which assesses, plans, implements, coordinates, monitors and evaluates the options and services for a patient’s individual health needs under the Scope of Service for the department. Provides linkages, referrals, coordination, and follow-up for identified patients and those who qualify for Health Homes. Coordinates follow-up appointments with patient’s Primary Care Physician /Patient Center Medical Home/ Health Home based on risk status. Responsibilities include meeting all compliance and regulatory agency guidelines. 🔍 What You’ll Do + Assesses patients within service line to identify needs according to established guidelines & Care Management policies. Coordinates care, monitors patient progress daily, and establishes discharge goals based on the care plan and patient outcomes with input from the interdisciplinary team. Completes CM assessments and LACE tool readmission risk determinations for identified patients such as those with chronic diseases (CHF, RF, COPD, MI, PN & DM as well as those previously re-admitted or identified at-risk patients). Documents the care plan and goals in the medical record according to policy guidelines. Utilizes MCG- Milliman criteria to identify severity of illness & intensity of service for appropriate utilization management and 1st level criteria reviews. Documents required data in Allscripts and follow the Care Management Plan Policy for utilization review & management. Follows through with the attending physician regarding patient status and level of care. As needed, consult internal and external physician advisors for 2nd level reviews. Initiates community resource referrals as needed based on patient choice and post-hospitalization needs for discharge and transfer. Coordinates interdisciplinary collaboration to achieve patient safety and a safe discharge plan. Maintains a working knowledge of the resources available in the community and the requirements of government payers and managed care organizations. Provides appropriate linkages, referral coordination, and follow-up for identified patients and those requiring Health Homes and other transitions. 📋 What You Bring + BSN preferred (or matriculating towards degree achievement) + Minimum of 3 years acute care hospital experience + Knowledgeable of New York State and Federal Entitlement Programs and regulatory requirements. Certifications / Licensure + Current NYS RN nursing license + PRI Certification preferred + CCM Certification preferred 🙌 Why Saratoga Hospital + A caring, community-focused culture rooted in teamwork and trust + Supportive leadership that invests in your development and well-being + Comprehensive benefits, including medical, dental, retirement plans, tuition assistance, and wellness programs. Click here to view our complete benefits guide. (https://www.albanymed.org/wp-content/uploads/sites/2/2025/01/2025-Benefits-Guide\_-Web-compressed-copy.pdf) + Opportunities to grow within the Albany Med Health System + Located in beautiful Saratoga Springs (https://www.discoversaratoga.org/) , known for its vibrant community, outdoor recreation, and cultural attractions 🤝 Our Commitment We are an equal opportunity employer and strongly encourage individuals of all backgrounds and experiences to apply. If you’re passionate about healthcare and community service—even if you don’t meet every qualification listed—we’d still love to hear from you. 📝 How to Apply Click the ‘apply’ button to submit your resume and complete our online application. Applications are reviewed on a rolling basis—apply today and discover what makes Saratoga Hospital a special place to grow your career. Salary Range: $37.00 - $56.50 Compensation may vary based upon, but not limited to: overall experience and qualifications, shift, and location.