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Nurse Case Manager
2 months ago
VNS Health is seeking a skilled Nurse Case Manager to join our team. As a key member of our healthcare team, you will be responsible for providing high-quality, patient-centered care to our members.
Key Responsibilities- Coordinate and oversee the coordination of benefits and services for all members on your caseload.
- Complete care management and disease-specific assessments to identify member needs and develop effective care plans.
- Make timely telephonic care management calls to members based on risk level, providing education, coaching, and support to promote adherence to treatment plans.
- Resolve and coordinate complex issues and member complaints impacting the delivery of services, ensuring timely and effective resolution.
- Provide health education to members 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 members receive the necessary support to optimize their quality of life.
- Identify member 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 members and caregivers to obtain the healthcare and other services needed 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 physician treatment plans by providing education, coaching, and support.
- Educate, coordinate, and provide resources to reduce inappropriate utilization of emergency room (ER) and hospital services.
- 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.
- Protect the confidentiality of member information and adhere to company policies regarding confidentiality.
- Ensure compliance with payors' policies and procedures as well as all Federal and State regulations.
- Interpret and implement VNS Health policies, state, and federal regulations.
- Participate in special projects and perform other duties as assigned.
- License and current registration to practice as a Registered Professional Nurse in NYS required.
- Certified Case Manager - Commission for Case Manager Certification within 1 year of employment required.
- Associate's Degree in nursing required or Bachelor's Degree in nursing preferred.
- Minimum two years of experience in a health-related field required, with care management and/or managed care experience preferred.
- Proficiency in Microsoft Office applications required, with demonstrated analytical skills.
