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Clinical Care Specialist
2 months ago
VNS Health is seeking a skilled Nurse Care Coordinator 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 oversee the coordination of benefits and services for all members on your caseload, ensuring seamless care transitions and optimal health outcomes.
- Complete comprehensive care management and disease-specific assessments to identify patient needs and develop personalized care plans.
- Makes timely telephonic care management calls based on risk level, providing education, coaching, and support to patients and caregivers.
- Resolves and coordinates complex issues and member complaints impacting the delivery of services, ensuring timely resolution and patient satisfaction.
- Provides health education and support to patients and caregivers, empowering them to manage their health and make informed decisions.
- Assesses social determinants of health and provides care coordination to reduce or remove barriers to care, ensuring patients receive the necessary resources and support.
- Identifies patient safety issues and intervenes as necessary, referring to appropriate resources and services to ensure patient well-being.
- Coordinates the delivery of high-quality, cost-effective care based on a customized population model of care, supported by evidence-based clinical practice guidelines.
- Advocates for patients and caregivers to obtain necessary healthcare and services, ensuring optimal health outcomes and quality of life.
- Utilizes the Care Management process to set priorities, plan, organize, and implement interventions that are goal-directed towards self-care outcomes and transition to independent status.
- Promotes adherence to physician treatment plans by providing education, coaching, and support, ensuring patients receive the necessary care and services.
- Reduces inappropriate utilization of emergency room and hospital services by educating patients and caregivers on proper use of healthcare resources.
- Increases utilization of primary care, specialty care, preventive health, and guideline-based treatments within the network, as appropriate.
- Participates in interdisciplinary team meetings and provides input on customer service-related activities, ensuring seamless care coordination and patient satisfaction.
- Protects patient confidentiality and adheres to company policies regarding confidentiality, ensuring the highest level of patient trust and respect.
- Ensures compliance with payor policies and procedures as well as all Federal and State regulations, ensuring regulatory compliance and patient safety.
- Interprets and implements VNS Health policies and state and federal regulations, ensuring adherence to company standards and patient care guidelines.
- Associated degree in nursing or a bachelor's degree in physical therapy required.
- Minimum two years of experience as a registered nurse required.
- 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.
