**Registered Nurse Case Manager**
3 days ago
VNS Health is seeking a skilled and compassionate Registered Nurse to join our team as a Case Manager in Acute Care Case Management. As a key member of our healthcare team, you will play a vital role in ensuring the highest quality and cost-effective healthcare services for our patients.
Key Responsibilities- Assess patient needs and develop solutions that promote high-quality and cost-effective healthcare services.
- Manage providers, members, and team-generated requests for medical services, rendering clinical determinations in accordance with healthcare policies and applicable state and federal regulations.
- Deliver timely notification detailing clinical decisions and coordinate with management, subject matter experts, physicians, member representatives, and discharge planners to ensure care is appropriate, timely, and cost-effective.
- Work under general supervision and maintain accurate records of all care management activities.
- Participate in case conferences with management and identify opportunities for alternative care options to facilitate safe discharge and transition back into the community.
- Review covered and coordinated services in accordance with established plan benefits, application of evidence-based medical criteria, and regulatory requirements to ensure appropriate authorization of services and execution of the plan's fiduciary responsibilities.
- Identify and provide recommendations for improvement regarding department processes and procedures.
- Maintain current knowledge of organizational or state-wide trends that affect member eligibility and the need for issuance of Determination Notices.
- Improve clinical and cost-effective outcomes through ongoing member education, care management, and collaboration with IDT members.
- Provide input and recommendations for design and development of processes and procedures for effective member case management, efficient department operations, and excellent customer service.
- Current license to practice as a Registered Professional Nurse in New York State.
- Minimum two years of experience with strong cost containment/case management background or two years acute inpatient hospital experience in chronic or complex care.
- Knowledge of Medicare and Medicaid regulations.
- 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.
- Knowledge of Medicaid and/or Medicare regulations.
- Knowledge of Milliman criteria (MCG) preferred.
VNS Health is one of the nation's largest nonprofit home and community-based health care organizations. Our commitment to health and well-being drives us to provide innovative and compassionate care to our patients. We offer a range of health care services, solutions, and health plans designed to simplify the healthcare experience and meet the diverse and complex needs of those we serve.
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