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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: Conduct comprehensive reviews of member requests for services, including clinical record reviews and interviews with members, clinical staff, medical providers, and other relevant sources.
- Ensure Medical Necessity: Examine standards and criteria to ensure medical necessity and appropriateness of admissions, treatment, level of care, and lengths of stay.
- Authorize Services: Approve services or consult with medical directors when case does not meet medical necessity criteria.
- Comply with Regulations: Ensure compliance with state and federal regulatory standards and VNS Health policies and procedures.
- Participate in Case Conferences: Participate in case conferences with management to discuss member cases and develop plans of care.
- Identify Alternative Care Options: 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 Services: 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.
- Improve Clinical and Cost-Effective Outcomes: Improve clinical and cost-effective outcomes, such as reduction of hospital admissions and emergency department visits, through ongoing member education, care management, and collaboration with interdisciplinary team members.
- Current License: Current license to practice as a Registered Professional Nurse in New York State required.
- Certified Case Manager: Certified Case Manager preferred.
- Education: Associate's Degree in Nursing or a Master's degree in Occupational Therapy required.
- 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.
- Skills: Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills, and working knowledge of Microsoft Excel, PowerPoint, and Word.
VNS Health is one of the nation's largest nonprofit home and community-based health care organizations. We innovate in health care for more than 125 years, driven by our commitment to health and well-being. We help people live, age, and heal where they feel most comfortable, in their own homes, connected to their family and community.
