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Nurse Case Manager
2 months ago
VNS Health is seeking a skilled Registered Nurse to join our team as a Case Manager. As a key member of our care management team, you will play a vital role in coordinating and overseeing the delivery of high-quality, cost-effective care to our patients.
Key Responsibilities- Coordinates and/or oversees the coordination of benefits and services for all members on your caseload.
- Completes care management and disease-specific assessments.
- Makes timely telephonic care management calls based on risk level.
- Resolves and coordinates complex issues and member complaints impacting the delivery of services.
- Provides health education to member/caregiver.
- Assesses Social Determinants of Health (SDoH) and provides care coordination to reduce/remove barriers to care.
- Identifies member safety issues and intervenes as necessary or refers to appropriate resources.
- Coordinates the delivery of high-quality, cost-effective care based on a customized population model of care supported by evidence-based clinical practice guidelines.
- Advocates for the member/caregiver to obtain the healthcare and other services needed to optimize their quality of life.
- Utilizes the Care Management process to set priorities, plan, organize, and implement interventions that are goal-directed towards self-care outcomes and the transition to independent status.
- Promotes adherence to the physician treatment plan by providing education, coaching, and support.
- Educates, coordinates, and provides resources to reduce inappropriate utilization of emergency room (ER) and hospital services.
- Increases utilization of primary care, specialty care, preventive health, and guideline-based treatments, including proper pharmacotherapy within network, as appropriate.
- Participates in interdisciplinary team (IDT) meetings and provides input on customer service-related activities.
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
- Ensures compliance with payors' policies and procedures as well as all Federal and State regulations.
- Interprets and implements VNS Health policies, state, and federal regulations.
- Associated degree in nursing or a bachelor's degree in physical therapy required.
- Minimum two years of experience as a registered nurse.
- License and current registration to practice as a Registered Professional Nurse or Physical Therapist or Occupational Therapist in the State of New York required.
- Population Care Coordination Certification preferred.
- Care Management, Case Management, OASIS, or other application certification preferred.
