Staff Nurse I
3 days ago
VNS Health is seeking a skilled Registered Nurse to join our team as a Case Manager. As a key member of our healthcare team, you will be responsible for assessing member needs and identifying solutions that promote high-quality and cost-effective healthcare services.
Key Responsibilities:- Assess member needs and develop comprehensive care plans to ensure timely and cost-effective healthcare services.
- Manage providers, members, and team-generated requests for medical services, rendering clinical determinations in accordance with healthcare policies and regulations.
- Deliver timely notification detailing clinical decisions and coordinate with management, subject matter experts, physicians, and member representatives to ensure care is appropriate, timely, and cost-effective.
- Work under general supervision to ensure compliance with state and federal regulations and VNS Health policies and procedures.
- Participate in case conferences with management and identify opportunities for alternative care options to facilitate safe discharge and transition back into the community.
- Review covered and coordinated services in accordance with established plan benefits, application of evidence-based medical criteria, and regulatory requirements to ensure appropriate authorization of services and execution of the plan's fiduciary responsibilities.
- Identify and provide recommendations for improvement regarding department processes and procedures.
- Maintain current knowledge of organizational or state-wide trends that affect member eligibility and the need for issuance of Determination Notices.
- Improve clinical and cost-effective outcomes through ongoing member education, care management, and collaboration with IDT members.
- Provide input and recommendations for design and development of processes and procedures for effective member case management, efficient department operations, and excellent customer service.
- Maintain accurate records of all care management, including written progress notes and verbal communications according to program guidelines.
- Participate in approval for out-of-network services when members receive services outside of VNS Health network services.
- Provide case direction and assistance to ensure quality and appropriate service delivery.
- Keep current with all health plan changes and updates through ongoing training, coaching, and educational materials.
- Current license to practice as a Registered Professional Nurse in New York State required.
- Certified Case Manager preferred.
- 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.
- 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, PowerPoint, and Word and strong typing skills required.
- Knowledge of Medicaid and/or Medicare regulations required.
- Knowledge of Milliman criteria (MCG) preferred.
- 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.
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Staff Nurse I
3 days ago
Cliffside Park, New Jersey, United States VNS Health Full timeJob DescriptionVNS Health is seeking a skilled Registered Nurse to join our team as a Case Manager. As a key member of our healthcare team, you will be responsible for assessing member needs and identifying solutions that promote high-quality and cost-effective healthcare services.Key Responsibilities:Assess member needs and develop comprehensive care plans...
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Staff Nurse I
3 days ago
Cliffside Park, New Jersey, United States VNS Health Full timeJob DescriptionVNS Health is seeking a skilled Registered Nurse to join our team as a Case Manager. As a key member of our healthcare team, you will be responsible for assessing member needs and identifying solutions that promote high-quality and cost-effective healthcare services.Key Responsibilities:Assess member needs and develop comprehensive care plans...
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Staff Nurse Educator
1 day ago
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Staff Nurse Part Time- Assisted Living
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Staff Nurse Part Time- Assisted Living
2 days ago
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Medical Staff Specialist
2 days ago
Cliffside Park, New Jersey, United States VNS Health Full timeJob Title: Medical Staff SpecialistVNS Health is seeking a highly skilled Medical Staff Specialist to join our team. As a Medical Staff Specialist, you will be responsible for providing expert care to patients with complex wounds and conditions.Key Responsibilities:Develop and implement population/disease management programs to improve clinical...
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Medical Staff Specialist
1 day ago
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Medical Staff Specialist
2 days ago
Cliffside Park, New Jersey, United States VNS Health Full timeJob Title: Medical Staff SpecialistVNS Health is seeking a highly skilled Medical Staff Specialist to join our team. As a Medical Staff Specialist, you will be responsible for providing expert care to patients with complex wounds and conditions.Key Responsibilities:Develop and implement population/disease management programs to improve clinical...
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Staff Nurse Part Time- Assisted Living
2 days ago
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Staff Nurse Part Time- Assisted Living
2 days ago
Cliffside Park, New Jersey, United States VNS Health Full timeJob Title: Staff Nurse Part Time- Assisted LivingVNS Health is seeking a skilled and compassionate Registered Nurse (RN) to join our team as a Staff Nurse Part Time- Assisted Living. As a key member of our nursing team, you will be responsible for providing high-quality patient care and support to our clients in their homes.Job Summary:We are looking for a...
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Staff Nurse Part Time- Assisted Living
1 day ago
Cliffside Park, New Jersey, United States VNS Health Full timeJob Title: Staff Nurse Part Time- Assisted LivingVNS Health is seeking a skilled and compassionate Registered Nurse (RN) to join our team in Cliffside Park, New Jersey.Job Summary:We are looking for a dedicated and experienced Registered Nurse to provide high-quality care to our patients in a skilled nursing setting. As a Staff Nurse, you will be responsible...
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Staff Nurse Part Time- Assisted Living
1 day ago
Cliffside Park, New Jersey, United States VNS Health Full timeJob Title: Staff Nurse Part Time- Assisted LivingVNS Health is seeking a skilled and compassionate Registered Nurse (RN) to join our team in Cliffside Park, New Jersey.Job Summary:We are looking for a dedicated and experienced Registered Nurse to provide high-quality care to our patients in a skilled nursing setting. As a Staff Nurse, you will be responsible...
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Medical Staff Specialist
3 days ago
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Medical Staff Specialist
1 day ago
Cliffside Park, New Jersey, United States VNS Health Full timeJob Title: Medical Staff SpecialistVNS Health is seeking a highly skilled Medical Staff Specialist to join our team. As a key member of our healthcare team, you will be responsible for managing the wound care program and providing clinical education to staff.Responsibilities:Manage the wound care program, including monitoring systems and tracking of wound...
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Staff Nurse Part Time- Assisted Living
1 day ago
Cliffside Park, New Jersey, United States VNS Health Full timeJob Title: Staff Nurse Part Time- Assisted LivingVNS Health is seeking a skilled and compassionate Registered Nurse (RN) to join our team in Cliffside Park, New Jersey.Job Summary:We are looking for a dedicated and experienced RN to provide high-quality care to our patients in their homes. As a Staff Nurse Part Time- Assisted Living, you will be responsible...
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Medical Staff Specialist
1 day ago
Cliffside Park, New Jersey, United States VNS Health Full timeJob Title: Medical Staff SpecialistVNS Health is seeking a highly skilled Medical Staff Specialist to join our team. As a key member of our healthcare team, you will be responsible for managing the wound care program and providing clinical education to staff.Responsibilities:Manage the wound care program, including monitoring systems and tracking of wound...
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Medical Staff Specialist
2 days ago
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Nurse Educator
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