Per Diem RN Care Manager

5 days ago

New York, New York, United States VNS Health Full time
About the Role

VNS Health is seeking a skilled RN Care Manager to join our team on a per diem basis. As a RN Care Manager, you will play a critical role in 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 member requests for services, including clinical record reviews and interviews with members, clinical staff, and medical providers.
    • Examine standards and criteria to ensure medical necessity and appropriateness of admissions, treatment, and lengths of stay.
    • Perform prior authorization and concurrent reviews to ensure extended treatment is medically necessary and being conducted in the right setting.
  • Coordinate Care and Services
    • Coordinate with management, subject matter experts, physicians, member representatives, and discharge planners to ensure care is appropriate, timely, and cost-effective.
    • Work with community providers to ensure efficient and effective transitions and delivery of care in the home and community.
  • Communicate with Stakeholders
    • Deliver timely notification detailing clinical decisions to members, providers, and other stakeholders.
    • Provide education to patients and their families to better understand their disease and diagnosis.
  • Collaborate with Interdisciplinary Teams
    • Participate in case conferences with management and interdisciplinary teams to coordinate care and services.
    • Consult with the member, family, and members of the inter-disciplinary team to coordinate the treatment plan, education, self-care techniques, and prevention strategies.
  • Ensure Compliance and Quality
    • Ensure compliance with state and federal regulatory standards and VNS Health policies and procedures.
    • Participate in special projects and perform other duties as assigned.
    Requirements
    • Licenses and Certifications
      • Current license to practice as a Registered Professional Nurse in New York State required.
      • Certified Case Manager 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.
    • 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.

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