We have other current jobs related to this field that you can find below
-
Registered Nurse
3 days ago
Edgewater, United States South River Healthcare Center Full time*Deeper Compassion, Higher Purpose*We help registered nurses gain new skills and grow in their careers in a supportive, family-like environment!*South River Healthcare Center* is seeking RNs with heart, empathy, and a little extra love to provide to our patients.We conduct Walk-in Interviews Monday-Friday from 10a-3pm.*We have new nursing management, come...
-
Registered Nurse
6 days ago
Edgewater, United States South River Healthcare Center Full time*Deeper Compassion, Higher Purpose*We help registered nurses gain new skills and grow in their careers in a supportive, family-like environment!*South River Healthcare Center* is seeking RNs with heart, empathy, and a little extra love to provide to our patients.We conduct Walk-in Interviews Monday-Friday from 10a-3pm.*We have new nursing management, come...
-
Emergency Room Registered Nurse
4 days ago
Edgewater, New Jersey, United States Swedish Belmar ER Full timePosition Overview Hourly Wage Estimate: $50.65 / hourExplore the comprehensive benefits available for this role.The displayed estimate reflects the typical wage range for candidates. Factors influencing your actual salary may include your specific skills, years of experience, and comparisons to other employees in this position. Typically, candidates are...
-
Registered Nurse, PRN
3 days ago
Edgewater, United States South River Healthcare Center Full time*Deeper Compassion, Higher Purpose*We help registered nurses gain new skills and grow in their careers in a supportive, family-like environment!*South River Healthcare Center* is seeking RNs with heart, empathy, and a little extra love to provide to our patients.*PRN Positions Available*We conduct Walk-in Interviews Monday-Friday from...
-
Home Health Registered Nurse
5 months ago
Edgewater, United States Waypoint Medical North Llc Full timeJob DescriptionJob DescriptionWe are seeking a Home Health Registered Nurse to join our team! You will be responsible for the assessment, diagnosis, and treatment of assigned patients.Responsibilities:Administer nursing care to ill, injured, or disabled patientsDiagnose and establish patient treatment plansMonitor and report changes in patient symptoms or...
-
Registered Nurse
3 weeks ago
Edgewater, United States Swedish Belmar ER Full timeDescription Hourly Wage Estimate: $33.77 - $50.65 / hourLearn more about the benefits offered for this job. The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in...
-
Registered Nurse
1 month ago
Edgewater, United States Halifax Health Full timeRegistered Nurse - Hospice Overview Halifax Health - Hospice is seeking a Registered Nurse for our Summary The Hospice RN will be responsible for coordination and implementation of the overall plan of care for the assigned patients in various hospice settings to assure the best possible quality of life is attained. Job Qualifications Currently licensed as an...
-
Edgewater, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Clinic for a nursing job in Edgewater, New Jersey.Job Description & RequirementsSpecialty: ClinicDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffOur clinical care management services are anchored in evidence-based practices to optimize the utilization of healthcare benefits and services. We...
-
Edgewater, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Clinic Case Management for a nursing job in Edgewater, New Jersey.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffEnsures the quality, safe delivery, and cost-effective home care services. Coordinates home care services that reflect VNS...
-
Edgewater, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Home Health Infusion for a nursing job in Edgewater, New Jersey.Job Description & RequirementsSpecialty: InfusionDiscipline: RNStart Date: 09/06/2024Duration: OngoingEmployment Type: StaffProvides services, treatments and procedures for patients that are ordered by authorized practitioners and in accordance with...
-
Edgewater, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Home Health for a nursing job in Edgewater, New Jersey.Job Description & RequirementsSpecialty: Home HealthDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffVNS Health Home Care RNs redefine the standard of patient-centered care for New Yorkers while keeping them out of the crowded hospital...
-
Edgewater, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Home Health Hospice for a nursing job in Edgewater, New Jersey.Job Description & RequirementsSpecialty: HospiceDiscipline: RNStart Date: 09/09/2024Duration: OngoingEmployment Type: StaffVNS Health Home Care RNs redefine the standard of patient-centered care for New Yorkers while keeping them out of the crowded...
-
Edgewater, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Home Health Field Supervisor for a nursing job in Edgewater, 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...
-
Edgewater, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Home Health Maternal - Newborn for a nursing job in Edgewater, New Jersey.Job Description & RequirementsSpecialty: Maternal - NewbornDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffVNS Health Home Care RNs redefine the standard of patient-centered care for New Yorkers while keeping them out...
-
Edgewater, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Home Health Maternal - Newborn for a nursing job in Edgewater, New Jersey.Job Description & RequirementsSpecialty: Maternal - NewbornDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffVNS Health Home Care RNs redefine the standard of patient-centered care for New Yorkers while keeping them out...
-
Edgewater, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Wound Care for a nursing job in Edgewater, New Jersey.Job Description & RequirementsSpecialty: Wound CareDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffManages the monitoring systems used for the evaluation and tracking of the wound management program and initiatives for all VNS Health...
-
Edgewater, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Manager, Program Manager for a nursing job in Edgewater, New Jersey.Job Description & RequirementsSpecialty: Program ManagerDiscipline: RNStart Date: 08/30/2024Duration: OngoingEmployment Type: StaffManages the day-to-day activities of one or more of the Population Health specialized programs or products. ...
-
Edgewater, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Manager, Educator for a nursing job in Edgewater, New Jersey.Job Description & RequirementsSpecialty: EducatorDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffPlans, manages, and evaluates clinical orientation and ongoing education and training programs for staff for one or more programs...
-
Edgewater, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Educator for a nursing job in Edgewater, New Jersey.Job Description & RequirementsSpecialty: EducatorDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffAre you passionate about shaping the future of healthcare through education? Join us at VNS Health Plans as an Education Manager (RN) and make a...
-
Edgewater, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Edgewater, New Jersey.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines Managed...
Registered Nurse
2 months ago
VNS Health is seeking a Registered Nurse (RN) Clinic for a nursing job in Edgewater, New Jersey.
Job Description & Requirements- Specialty: Clinic
- Discipline: RN
- Start Date: ASAP
- 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 plans 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.
For Care Management Only:
- Assesses, plans, facilitates and advocates for options and services to effectively manage an individuals health needs. Promotes quality and cost-effective outcomes at all times.
- Provides telephonic case management to members, balancing clinical, social, and environmental concerns.
- Provides analysis of initial health evaluation and comprehensive assessment of the member/family psychosocial status and case management needs. Participates in the development, coordination and implementation of the care plan to address specific needs of the member/family including thorough transitions between settings of care.
- Coordinates with community providers to ensure efficient and effective transitions and delivery of care in the home and community.
- Consults with the member, family, and members of the inter-disciplinary team to coordinate the treatment plan, education, self-care techniques and prevention strategies.
- Verifies that all aspects of the clinical record are in agreement with the members clinical and functional status. Utilizes VNS Health and state approved assessment and documentation as well as interviews with members, family, and care providers in decision-making.
- Performs annual clinical co-visits for nurses as well as two initial co-visits during the first six months for new hires as follows: one within first three weeks and a second within the first six months. Provides feedback to therapist and management; assists in development of plans to address improvement needs as appropriate.
- 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
Education:
- Associate's Degree in Nursing or a Masters degree in Occupational Therapy required
- Bachelor's Degree or Masters 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
VNS Health Job ID #R010395. Posted job title: Clinical Evaluation Manager (Rn Social Work Social Worker)
About VNS HealthVNS Health is one of the nations 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 uswe 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
