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Nurse Case Manager

2 months ago

Fairview, New Jersey, United States VNS Health Full time
About the Role

VNS Health is seeking a skilled professional to fill the position of Nurse Case Manager, Acute Care Case Management. As a key member of our 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.
  • Clinical Decision Making: 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 Coordination: Ensure compliance with state and federal regulatory standards and VNS Health policies and procedures. Participate in case conferences with management and identify opportunities for alternative care options.
  • Communication and Collaboration: Provide timely notification detailing clinical decisions and coordinate with management, subject matter experts, physicians, member representatives, and discharge planners to ensure care is appropriate, timely, and cost-effective.
  • Record Keeping and Reporting: Maintain accurate records of all care management, including written progress notes and verbal communications according to program guidelines.
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.
About VNS Health

VNS Health is one of the nation's largest nonprofit home and community-based healthcare organizations. Our commitment to health and well-being drives us to provide compassionate care, unparalleled expertise, and 24/7 solutions and resources to those we serve.

Benefits
  • Guaranteed Hours
  • 401k retirement plan
  • Employee assistance programs
  • Dental benefits
  • Vision benefits
  • License and certification reimbursement
  • Life insurance
  • Discount program
  • Holiday Pay
  • Continuing Education
  • Wellness and fitness programs
  • Mileage reimbursement
  • Medical benefits
  • Benefits start day 1