Nurse Case Manager

4 days ago


Hoboken, 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 a dynamic and challenging role. 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
  • Assessment and Planning: 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.
  • Medical Necessity and Appropriateness: Examine standards and criteria to ensure medical necessity and appropriateness of admissions, treatment, level of care, and lengths of stay. Perform prior authorization and concurrent reviews to ensure extended treatment is medically necessary and being conducted in the right setting.
  • Compliance and Regulatory Requirements: Ensure compliance with state and federal regulatory standards and VNS Health policies and procedures.
  • Case Conferences and Collaboration: Participate in case conferences with management and collaborate with IDT members to improve clinical and cost-effective outcomes.
  • Record Keeping and Communication: Maintain accurate records of all care management, including written progress notes and verbal communications according to program guidelines.
Requirements
  • 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.
  • 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.
  • Licenses and Certifications: Current license to practice as a Registered Professional Nurse or an Occupational Therapist in New York State required. Certified Case Manager preferred.
About VNS Health

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 members. We offer a range of benefits, including guaranteed hours, 401k retirement plan, employee assistance programs, and more.


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