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Registered Nurse Care Manager
2 months ago
VNS Health is seeking a highly skilled Registered Nurse Care Manager to join our team. As a key member of our care management team, you will play a vital role in ensuring our members receive high-quality, cost-effective healthcare services.
Key Responsibilities- Assess member needs and identify solutions that promote high-quality and cost-effective healthcare services.
- Manage providers, members, team, or care manager-generated requests for medical services and render clinical determinations in accordance with healthcare policies as well as applicable state and federal regulations.
- Deliver timely notification detailing clinical decisions.
- Coordinate with management, subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is appropriate, timely, and cost-effective.
- Work under general supervision.
- Referral bonus opportunities.
- Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays.
- Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life, and Disability.
- Employer-matched retirement saving funds.
- Personal and financial wellness programs.
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care.
- Generous tuition reimbursement for qualifying degrees.
- Opportunities for professional growth and career advancement.
- Internal mobility.
- Current license to practice as a Registered Professional Nurse or an Occupational Therapist in New York State required.
- Certified Case Manager preferred.
- For SelectHealth ETE Only: Nurse Practitioner (NP) certification with background or degree in Public Health preferred.
- Education: Associate's Degree in Nursing or a Master's degree in Occupational Therapy required.
- Bachelor's Degree or Master's degree in nursing 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. preferred.
- Knowledge of Medicare and Medicaid regulations required.
- Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills.
- Working knowledge of Microsoft Excel, Power-Point, and Word and strong typing skills required.
- Knowledge of Medicaid and/or Medicare regulations required.
- Knowledge of Milliman criteria (MCG) preferred.
- For SelectHealth ETE Only: Experience in Public Health programming, delivery, and evaluation preferred.
- Experience working with community-based organizations in underserved communities preferred.
