Nurse Case Manager
4 days ago
VNS Health is seeking a skilled Nurse Case Manager to join our team. As a key member of our healthcare team, you will play a vital role in coordinating and overseeing the delivery of high-quality, cost-effective care to our patients.
Key Responsibilities- Coordinate and/or oversee the coordination of benefits and services for all members on your caseload.
- Complete care management and disease-specific assessments to identify patient needs and develop personalized care plans.
- Make timely telephonic care management calls to patients based on risk level, ensuring timely interventions and optimal health outcomes.
- Resolve and coordinate complex issues and patient complaints impacting the delivery of services, providing exceptional customer service and ensuring patient satisfaction.
- Provide health education to patients and caregivers, empowering them to take an active role in their healthcare.
- Assess social determinants of health and provide care coordination to reduce or remove barriers to care, ensuring patients receive the necessary support to achieve optimal health outcomes.
- Identify patient safety issues and intervene as necessary, referring to appropriate resources such as community linkages, dietary, therapy, HHA services, behavioral health, and DME.
- Coordinate the delivery of high-quality, cost-effective care based on a customized population model of care supported by evidence-based clinical practice guidelines.
- Advocate for patients and caregivers to obtain the necessary healthcare and other services to optimize their quality of life.
- Utilize 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.
- Promote adherence to the physician treatment plan by providing education, coaching, and support, ensuring patients receive the necessary care to achieve optimal health outcomes.
- Reduce inappropriate utilization of emergency room (ER) and hospital services by educating, coordinating, and providing resources to patients and caregivers.
- Increase utilization of primary care, specialty care, preventive health, and guideline-based treatments, including proper pharmacotherapy within network, as appropriate.
- Participate in interdisciplinary team (IDT) meetings and provide input on customer service-related activities, ensuring seamless communication and collaboration among team members.
- Protect the confidentiality of patient information and adhere to company policies regarding confidentiality, ensuring the highest level of patient trust and satisfaction.
- Ensure compliance with payors' policies and procedures, as well as all Federal and State regulations, maintaining the highest level of professionalism and integrity.
- Interpret and implement VNS Health policies, state, and federal regulations, ensuring adherence to all relevant guidelines and standards.
- Associated degree in nursing or a bachelor's degree in physical therapy required.
- Minimum two years of experience as a registered nurse.
- License and current registration to practice as a Registered Professional Nurse or Physical Therapist or Occupational Therapist in the State of New York required.
- Population Care Coordination Certification preferred.
- Care Management, Case Management, OASIS, or other application certification preferred.
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