Clinical Care Manager, RN

Found in: Careerbuilder One Red US C2 - 2 weeks ago


New York NY United States VNS Health Full time
Overview

Provides telephonic clinical care management services using evidence-based practices to ensure effective utilization of benefits, services, and care is provided to the patients allowing them to remain safely in their home/community.


Compensation:

$93,400.00 - $116,800.00 Annual

What We Provide

  • Referral bonus opportunities

  • Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays

  • Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability

  • Employer-matched retirement saving funds

  • Personal and financial wellness programs

  • Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care

  • Generous tuition reimbursement for qualifying degrees

  • Opportunities for professional growth and career advancement

  • Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

  • Coordinates and/or oversees the coordination of benefits and services for all members on his/her caseload.

  • Completes care management and disease specific assessments.

  • Makes timely telephonic care management calls based on risk level.

  • Resolves and coordinates complex issues and member complaints impacting the delivery of services.

  • Provides health education to member/caregiver.

  • Assess SDoH and provide care coordination to reduce/remove barriers of care to include ability to allow for changing levels of care based on assessments, trigger events and program data/reports.

  • Identifies member safety issues and intervenes as necessary or refers to appropriate resources, such as community linkages, dietary, therapy (PT/OT/ST), HHA services, behavioral health, and DME.

  • Coordinates the delivery of high quality, cost-effective care based on a customized population model of care supported by evidence based clinical practice guidelines.

  • Advocates for the member/caregiver to obtain the health care and other services needed to optimize their quality of life.

  • Utilizes the Care Management process to set priorities, plan, organize and implement interventions that are goal directed towards self-care outcomes and the transition to independent status.

  • Promotes adherence to the physician treatment plan by providing education, coaching and support.

  • Educates, coordinates, and provides resources to reduce inappropriate utilization of emergency room (ER) and hospital service.

  • Increases utilization of primary care, specialty care, preventive health and guideline-based treatments including proper pharmacotherapy within network, as appropriate.

  • Participates in interdisciplinary team (IDT) meetings and provide input on customer service-related activities.

  • Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

  • Ensures compliance with payors’ policies and procedures as well as all Federal and State regulations.

  • Interprets and implements VNS Health policies, state and federal regulations.

  • Participates in special projects and performs other duties as assigned.


Qualifications

Licenses and Certifications:

  • License and current registration to practice as a Registered Professional Nurse in NYS required

  • Population Care Coordination certification preferred

  • Care Management, Case Management, OASIS or other applicable certification preferred


Education:

  • Associate's Degree in nursing required

  • Bachelor's Degree in nursing preferred


Work Experience:

  • Minimum two years of experience as a registered nurse required

  • Care management and/or managed care experience preferred

  • Proficiency in Microsoft Office applications required

  • Demonstrated analytical skills required



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