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Nurse Case Manager

2 months ago

Elizabeth, New Jersey, United States HealthEcareers - Client Full time
About the Role

VNS Health is seeking a skilled Nurse Case Manager to join our team in Union City, New Jersey. As a key member of our Acute Care Case Management team, you will play a vital role in assessing member needs and identifying solutions that promote high-quality and cost-effective healthcare services.

Key Responsibilities
  • Conduct comprehensive reviews of requests for services, including clinical record reviews and interviews with members, clinical staff, medical providers, and other relevant sources.
  • Examine standards and criteria to ensure medical necessity and appropriateness of admissions, treatment, and lengths of stay.
  • Perform prior authorization and concurrent reviews to ensure extended treatment is medically necessary and being conducted in the right setting.
  • Ensure compliance with state and federal regulatory standards and VNS Health policies and procedures.
  • Participate in case conferences with management and identify opportunities for alternative care options.
Requirements
  • 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.
  • Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills.
About VNS Health

VNS Health is one of the nation's largest nonprofit home and community-based healthcare organizations. We innovate in healthcare for over 125 years, driven by our commitment to health and well-being. We help people live, age, and heal where they feel most comfortable, in their own homes, connected to their family and community.

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