RN Case Manager

2 days ago


Secaucus, New Jersey, United States VNS Health Full time
VNS Health Job Opportunity

We are seeking a skilled Registered Nurse (RN) to join our team as a Case Manager. This role involves providing telephonic clinical care management services to ensure effective utilization of benefits, services, and care for patients.

Key Responsibilities:
  • Coordinate benefits and services for assigned members
  • Complete care management and disease-specific assessments
  • Make timely telephonic care management calls based on risk level
  • Resolve and coordinate complex issues and member complaints
  • Provide health education to members and caregivers
  • Assess social determinants of health and provide care coordination
  • Coordinate delivery of high-quality, cost-effective care
  • Advocate for members and caregivers to obtain healthcare and other services
  • Educate, coordinate, and provide resources to reduce inappropriate utilization of emergency room (ER) and hospital services
  • Participate in interdisciplinary team (IDT) meetings
  • Protect the confidentiality of member information
  • Ensure compliance with payors' policies and procedures
  • Interpret and implement VNS Health policies, state, and federal regulations
Requirements:
  • License and current registration to practice as a Registered Professional Nurse in NYS
  • Certified Case Manager - Commission for Case Manager Certification within 1 year of employment
  • Associate's Degree in nursing required, Bachelor's Degree in nursing preferred
  • Minimum two years of experience in a health-related field
  • Care management and/or managed care experience preferred
  • Proficiency in Microsoft Office applications and demonstrated analytical skills required

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