Clinical Care Manager, Registered Nurse, Chronic Care Management (Mostly Remote) en Visiting Nurse Service of New York d/b/a VNS Health
Visiting Nurse Service of New York d/b/a VNS Health · New York, Estados Unidos De América · Hybrid
- Professional
- Oficina en New York
Overview:Provides telephonic clinical care management services using evidence-based practices to ensure effective utilization of benefits, services, and care is provided to the patients allowing them to remain safely in their home/community.Responsibilities:
What We Provide
- Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
- Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement
- Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
- Referral bonus opportunities
What You Will Do
- Coordinates and/or oversees the coordination of benefits and services for all members on his/her 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.
- Assess SDoH and provide care coordination to reduce/remove barriers of care to include ability to allow for changing levels of care based on assessments, trigger events and program data/reports.
- Identifies member safety issues and intervenes as necessary or refers to appropriate resources, such as community linkages, dietary, therapy (PT/OT/ST), HHA services, behavioral health, and DME.
- 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 health care 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 service.
- 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 provide 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.
- Participates in special projects and performs other duties as assigned.
Licenses and Certifications:
- License and current registration to practice as a Registered Professional Nurse in NYS required
- Certified Case Manager - Commission for Case Manager Certification within 1 year of employment required
Education:
- Associate's Degree in nursing required
- Bachelor's Degree in nursing preferred
Work Experience:
- Minimum two years of experience in health related field required
- Care management and/or managed care experience preferred
- Proficiency in Microsoft Office applications required
- Demonstrated analytical skills required
