Registered Nurse

7 days ago

Ridgefield NJ United States VNS Health Full time

VNS Health is seeking a Registered Nurse (RN) Care Manager for a nursing job in Ridgefield, New Jersey.

Job Description & Requirements
  • Specialty: Care Manager
  • Discipline: RN
  • Start Date: 09/23/2024
  • Duration: Ongoing
  • Employment Type: Staff

Assesses member needs and identifies solutions that promote high quality and cost-effective health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state and federal regulations. Delivers timely notification detailing clinical decisions. Coordinates with management, subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is appropriate, timely and cost effective. Works under general supervision.

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

  • Conducts comprehensive review of all components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical providers, paraprofessional staff, caregivers and other relevant sources as necessary.
  • Examines standards and criteria to ensure medical necessity and appropriateness of admissions, treatment, level of care and lengths of stay. Performs prior authorization and concurrent reviews to ensure extended treatment is medically necessary and being conducted in the right setting. Reviews requests for outpatient and inpatient admission; approves services or consults with medical directors when case does not meet medical necessity criteria.
  • Ensures compliance with state and federal regulatory standards and VNS Health policies and procedures.
  • Participates in case conferences with management.
  • Identifies opportunities for alternative care options and contributes to the development of patient focused plan of care to facilitate a safe discharge and transition back into the community after hospitalization.
  • Reviews covered and coordinated services in accordance with established plan benefits, application of evidenced based medical criteria, and regulatory requirements to ensure appropriate authorization of services and execution of the plan's fiduciary responsibilities.
  • Identifies and provides recommendations for improvement regarding department processes and procedures.
  • Maintains current knowledge of organizational or state-wide trends that affect member eligibility and the need for issuance of Determination Notices
  • Improves clinical and cost-effective outcomes such as reduction of hospital admissions and emergency department visits through on-going member education, care management and collaboration with IDT members.
  • Provides input and recommendations for design and development of, processes and procedures for effective member case management, efficient department operations, and excellent customer service.
  • Maintains accurate record of all care management. Maintains written progress notes and verbal communications according to program guidelines.
  • Participates in approval for out-of-network services when member receives services outside of VNS Health network services.
  • Provides case direction and assistance ensuring quality and appropriate service delivery.
  • Keeps current with all health plan changes and updates through on-going training, coaching and educational materials.
  • Provides clinical and programmatic support the to the ETE grant project.
  • Coordinates and participates in ETE conference calls with designated AIDS Centers (DAC) sites. Participates in weekly outreach team case conferences. Coordinates sharing of information between subcontractor Community Based Organizations (CBOs), DAC, and internal staff at VNS Health.
  • Participates in special projects and performs other duties as assigned.

Licenses and Certifications:

  • Current license to practice as a Registered Professional Nurse or an Occupational Therapist in New York State required
  • Certified Case Manager preferred
  • For SelectHealth ETE Only: Nurse Practitioner (NP) certification with background or degree in Public Health preferred


Education:

  • Associate's Degree in Nursing or a Master's degree in Occupational Therapy required
  • Bachelor's Degree or Master's degree in nursing preferred


Work Experience:

  • Minimum two years of experience with strong cost containment /case management background or two years acute inpatient hospital experience in chronic or complex care required
  • Must have experience and qualifications demonstrating knowledge of working with the LTSS eligible population. preferred
  • Knowledge of Medicare and Medicaid regulations required
  • Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills.
  • Working knowledge of Microsoft Excel, Power-Point, and Word and strong typing skills required
  • Knowledge of Medicaid and/or Medicare regulations required
  • Knowledge of Milliman criteria (MCG) preferred
  • For SelectHealth ETE Only: Experience in Public Health programming, delivery and evaluation preferred
  • Experience working with community-based organizations in underserved communities preferred

VNS Health Job ID #R Posted job title: Sh Rn Rn Care Manager

About VNS Health

VNS Health is one of the nation's largest nonprofit home and community-based health care organizations. Innovating in health care for more than 125 years, our commitment to health and well-being is what drives us—we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 "neighbors" who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of those we serve in New York and beyond.

Benefits
  • Guaranteed Hours
  • 401k retirement plan
  • Employee assistance programs
  • Dental benefits
  • Vision benefits
  • License and certification reimbursement
  • Life insurance
  • Discount program
  • Holiday Pay
  • Continuing Education
  • Wellness and fitness programs
  • Mileage reimbursement
  • Medical benefits
  • Benefits start day 1

  • Registered Nurse

    1 week ago

    Ridgefield, NJ, United States VNS Health Full time

    VNS Health is seeking a Registered Nurse (RN) Home Health Field Supervisor for a nursing job in Ridgefield, New Jersey.Job Description & RequirementsSpecialty: Field SupervisorDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffBy providing case management support including clinical intervention, development of care plans, and follow-up...

  • Home Health Weekend Registered Nurse

    3 months ago

    Bayonne, NJ, United States Bayonne Visiting Nurse Association - Bayonne Full time

    We are hiring for a full-time, Weekend Registered Nurse.  Work 36 hours, get paid for 40! Scheduling options are Friday, Saturday and Sunday, or Saturday, Sunday, and Monday!    At Bayonne VNA, a part of LHC Group, we embrace a culture of caring, belonging, and trust and enjoy the meaningful connections that come from it: for the whole...

  • RN Registered Nurse Home Health

    1 month ago

    Bayonne, NJ, United States Bayonne Visiting Nurse Association - Bayonne Full time

    We are hiring for a full-time Registered Nurse to join our team in Bayonne, NJ!     At Bayonne VNA, a part of LHC Group, we embrace a culture of caring, belonging, and trust and enjoy the meaningful connections that come from it: for the whole patient, their families, each other, and the communities we serve—it truly is all about helping...

  • Compassionate Hospice Registered Nurse

    2 weeks ago

    Ridgefield, Connecticut, United States RVNAhealth Full time

    Position Overview - Continuous Care Hospice Registered Nurse:We are seeking a dedicated and empathetic Registered Nurse to become a vital part of RVNAhealth. In the role of Continuous Care Nurse for Hospice, you will be tasked with delivering direct patient care, providing palliative nursing services, and offering bereavement support. This role demands...

  • Registered Nurse

    2 months ago

    Ridgefield, United States Benchmark Senior Living Full time

    JOIN A GREAT TEAM with GREAT BENEFITS!! NEW and COMPETITIVE WAGES!! If you are a motivated, caring, compassionate and organized Registered Nurse who is devoted to providing seniors with excellent care and unprecedented comfort, then join our team at Ridgefield Crossings! We are seeking a personable, enthusiastic, and dynamic Registered Nurse to join our...

  • Registered Nurse

    4 months ago

    Ridgefield, United States Benchmark Senior Living Full time

    JOIN A GREAT TEAM with GREAT BENEFITS!! NEW and COMPETITIVE WAGES!! If you are a motivated, caring, compassionate and organized Registered Nurse who is devoted to providing seniors with excellent care and unprecedented comfort, then join our team at Ridgefield Crossings! We are seeking a personable, enthusiastic, and dynamic Registered Nurse to join our...

  • RN Registered Nurse

    3 days ago

    Ridgefield, United States Advanced Recovery Systems Full time

    Overview:Seeking exceptional Registered Nurses to join our team in Ridgefield, WA!Starting Pay $45+/hr Depending on ExperienceShift Differentials: $4 Nights | $2 Weekends | $6 Weekend NightsAdvanced Recovery Systems (ARS) is an integrated behavioral healthcare management company committed to transforming lives through comprehensive treatment. With our...

  • Registered Nurse School SY

    2 weeks ago

    Ridgefield, United States Epic Special Education Staffing Full time

    ABOUT USTogether, we are the Epic Special Education Staffing family and family is how we view each member of this incredible community. From our family to the nation's schools, we remain focused on providing a world of opportunities for you to leverage your abilities and make an impact on special education. Apply today to join our family.POSITION...

  • Hospice Registered Nurse

    2 months ago

    Ridgefield, United States RVNAhealth Full time

    Job DescriptionJob DescriptionAre you a dedicated and caring Registered Nurse with a passion for providing exceptional patient and family care? Do you thrive in a community setting and excel at collaborating with interdisciplinary teams? At RVNAhealth, you can experience satisfying and challenging work that makes a real difference in peoples lives,. We are...

  • Registered Nurse Case Manager

    19 hours ago

    Ridgefield, New Jersey, United States VNS Health Full time

    Job Title: Registered Nurse Case ManagerVNS Health is seeking a skilled Registered Nurse Case Manager to join our team in Ridgefield, New Jersey.Job Summary:We are looking for a highly motivated and experienced Registered Nurse Case Manager to work in our Acute Care Case Management department. The successful candidate will be responsible for assessing member...

  • Registered Nurse Care Manager

    6 days ago

    Ridgefield, New Jersey, United States VNS Health Full time

    About the RoleVNS Health is seeking a highly skilled Registered Nurse Care Manager to join our team. As a key member of our care management team, you will play a vital role in ensuring our members receive high-quality, cost-effective healthcare services.Key ResponsibilitiesAssess Member Needs: Conduct comprehensive reviews of member requests for services,...

  • Registered Nurse School 2024-2025 SY

    2 weeks ago

    Ridgefield, United States Epic Special Education Staffing Full time

    ABOUT USTogether, we are the Epic Special Education Staffing family and family is how we view each member of this incredible community. From our family to the nation’s schools, we remain focused on providing a world of opportunities for you to leverage your abilities and make an impact on special education. Apply today to join our family.POSITION...

  • Registered Nurse School 2024-2025 SY

    2 weeks ago

    Ridgefield, United States Epic Special Education Staffing Full time

    ABOUT USTogether, we are the Epic Special Education Staffing family and family is how we view each member of this incredible community. From our family to the nation’s schools, we remain focused on providing a world of opportunities for you to leverage your abilities and make an impact on special education. Apply today to join our family.POSITION...

  • Registered Nurse

    2 weeks ago

    Berlin, VT, United States Nurse First Full time

    Nurse First is currently seeking a travel Registered Nurse specializing in Labor and Delivery for an exciting opportunity.Position Overview & RequirementsSpecialization: Labor and DeliveryRole: Registered Nurse (RN)Contract Duration: 25 weeks36 hours per weekShift Schedule: 12-hour night shiftsEmployment Type: TravelThe compensation package is structured...

  • **Care Manager

    6 days ago

    Ridgefield, New Jersey, United States VNS Health Full time

    About the RoleVNS Health is seeking a skilled Care Manager - Registered Nurse to join our team. As a key member of our healthcare team, you will play a vital role in ensuring our patients receive the highest quality care.Key ResponsibilitiesConduct comprehensive reviews of patient requests for services, including clinical record reviews and interviews with...

  • Registered Nurse

    2 weeks ago

    Berlin, VT, United States Nurse First Full time

    Nurse First is actively seeking a dedicated Registered Nurse for a travel assignment specializing in Med Surg / Telemetry.Position Overview & RequirementsSpecialty: Med Surg / TelemetryDiscipline: Registered Nurse (RN)Duration: 19 weeks36 hours per weekShift: 12-hour daytime shiftsEmployment Type: TravelThis position offers a competitive pay package based on...

  • Registered Nurse

    6 days ago

    Ridgefield, New Jersey, United States VNS Health Full time

    About the Role:VNS Health is seeking a skilled Registered Nurse to join our Home Health Infusion team. As a Home Health Infusion Nurse, you will provide high-quality patient care and deliver infusion therapy services in the comfort of patients' homes.Key Responsibilities:Assess patient needs and develop individualized care plans to ensure effective and safe...

  • Registered Nurse Care Manager

    1 day ago

    Ridgefield, Connecticut, United States HealthEcareers - Client Full time

    About the RoleWe are seeking a highly skilled Registered Nurse Care Manager to join our team at HealthEcareers - Client. As a key member of our care management team, you will play a vital role in ensuring our members receive high-quality, cost-effective healthcare services.Key ResponsibilitiesAssess and Coordinate CareConduct comprehensive reviews of member...

  • Registered Nurse Per Diem IV Infusion Therapy

    4 months ago

    Ridgefield, United States RVNAhealth Full time

    Job DescriptionJob DescriptionAt RVNAhealth, you can experience satisfying and challenging work that makes a real difference in peoples lives, every day. We are an agency where you can feel valued and achieve professional growth and development with personal fulfillment.Why RVNAhealth?RVNAhealth (formerly known as RVNA, the Ridgefield Visiting Nurse...

  • Registered Nurse Position in Educational Setting

    2 weeks ago

    Ridgefield, Connecticut, United States Sunbelt Staffing Full time

    Position OverviewWe are seeking a dedicated Registered Nurse (RN) to support the health and well-being of students in a school environment. Candidates should possess a minimum of 1+ years of nursing experience.Key Responsibilities:Provide nursing care to students in a school setting.Work full-time, up to 36.65 hours per week.Participate in a remote interview...