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Nurse Case Manager

2 months ago

Edgewater, New Jersey, United States VNS Health Full time
About the Role

VNS Health is seeking a skilled Nurse Case Manager to join our team in Edgewater, New Jersey. As a key member of our healthcare team, you will be responsible for assessing member needs and identifying solutions that promote high-quality and cost-effective healthcare services.

Key Responsibilities
  • Assess and Manage Member Needs
    • Conduct comprehensive reviews of all components related to 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, level of care, and lengths of stay.
  • Ensure Compliance and Quality
    • Ensure compliance with state and federal regulatory standards and VNS Health policies and procedures.
    • Participate in case conferences with management.
  • Coordinate Care and Services
    • Identify opportunities for alternative care options and contribute to the development of patient-focused plans of care to facilitate safe discharges and transitions back into the community.
    • Review covered and coordinated services in accordance with established plan benefits, application of evidence-based medical criteria, and regulatory requirements.
  • Provide Clinical and Programmatic Support
    • Provide case direction and assistance ensuring quality and appropriate service delivery.
    • Keep current with all health plan changes and updates through ongoing training, coaching, and educational materials.
  • Collaborate with Stakeholders
    • Coordinate and participate in ETE conference calls with designated AIDS Centers (DAC) sites.
    • Participate in weekly outreach team case conferences.
    Requirements
    • Education and Certifications
      • Current license to practice as a Registered Professional Nurse or an Occupational Therapist in New York State required.
      • Certified Case Manager preferred.
    • Work Experience
      • 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.
      • Must have experience and qualifications demonstrating knowledge of working with the LTSS eligible population.
    • Skills and Abilities
      • Excellent organizational and time management skills.
      • Interpersonal skills, verbal and written communication skills.
      • Working knowledge of Microsoft Excel, PowerPoint, and Word and strong typing skills required.
      About VNS Health

VNS Health is one of the nation's largest nonprofit home and community-based healthcare organizations. Our commitment to health and well-being drives us to provide innovative solutions and resources to those we serve. We offer a range of healthcare services, solutions, and health plans designed to simplify the healthcare experience and meet the diverse and complex needs of our members.

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
  • Mileage reimbursement
  • Medical benefits
  • Benefits start day 1