Healthcare Professional
1 week ago
VNS Health is seeking a skilled Nurse Care Coordinator to join our team. As a key member of our healthcare team, you will play a vital role in coordinating and overseeing the delivery of high-quality, cost-effective care to our patients.
Key Responsibilities- Coordinate and/or oversee the coordination of benefits and services for all members on your caseload.
- Complete care management and disease-specific assessments to identify patient needs and develop personalized care plans.
- Make timely telephonic care management calls to patients based on risk level and provide education and support to promote healthy behaviors.
- Resolve and coordinate complex issues and patient complaints impacting the delivery of services.
- Provide health education to patients and caregivers to empower them to manage their health effectively.
- Assess social determinants of health and provide care coordination to reduce or remove barriers to care, including the ability to adjust levels of care based on assessments, trigger events, and program data/reports.
- Identify patient safety issues and intervene as necessary or refer to appropriate resources, such as community linkages, dietary, therapy (PT/OT/ST), HHA services, behavioral health, and DME.
- Coordinate the delivery of high-quality, cost-effective care based on a customized population model of care supported by evidence-based clinical practice guidelines.
- Advocate for patients and caregivers to obtain the healthcare and other services needed to optimize their quality of life.
- Utilize 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.
- Promote adherence to the physician treatment plan by providing education, coaching, and support.
- Educate, coordinate, and provide resources to reduce inappropriate utilization of emergency room (ER) and hospital services.
- Increase utilization of primary care, specialty care, preventive health, and guideline-based treatments, including proper pharmacotherapy within network, as appropriate.
- Participate in interdisciplinary team (IDT) meetings and provide input on customer service-related activities.
- Protect the confidentiality of patient information and adhere to company policies regarding confidentiality.
- Ensure compliance with payors' policies and procedures as well as all Federal and State regulations.
- Interpret and implement 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.
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