staff - Registered Nurse (RN) - Case Manager, Acute Care Case Management - $85K-106K per year

VNS Health
Cliffside Park, NJ, US
$85K-$106K a year
Full-time

VNS Health is seeking a Registered Nurse (RN) Case Manager, Acute Care Case Management for a nursing job in Cliffside Park, New Jersey.

Job Description & Requirements

  • Specialty : Acute Care Case Management
  • Discipline : RN
  • Start Date : ASAP
  • Duration : Ongoing
  • Employment Type : Staff

Assesses member needs and identifies solutions that promote high quality and cost-effective health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state and federal regulations.

Delivers timely notification detailing clinical decisions. Coordinates with management, subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is appropriate, timely and cost effective.

Works under general supervision.

What We Provide

  • Referral bonus opportunities
  • 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 and 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

What You Will Do

  • Conducts comprehensive review of all components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical providers, paraprofessional staff, caregivers and other relevant sources as necessary.
  • Examines standards and criteria to ensure medical necessity and appropriateness of admissions, treatment, level of care and lengths of stay.

Performs prior authorization and concurrent reviews to ensure extended treatment is medically necessary and being conducted in the right setting.

Reviews requests for outpatient and inpatient admission; approves services or consults with medical directors when case does not meet medical necessity criteria.

  • Ensures compliance with state and federal regulatory standards and VNS Health policies and procedures.
  • Participates in case conferences with management.
  • Identifies opportunities for alternative care options and contributes to the development of patient focused plan of care to facilitate a safe discharge and transition back into the community after hospitalization.
  • Reviews covered and coordinated services in accordance with established plan benefits, application of evidenced based medical criteria, and regulatory requirements to ensure appropriate authorization of services and execution of the plan's fiduciary responsibilities.
  • Identifies and provides recommendations for improvement regarding department processes and procedures.
  • Maintains current knowledge of organizational or state-wide trends that affect member eligibility and the need for issuance of Determination Notices
  • Improves clinical and cost-effective outcomes such as reduction of hospital admissions and emergency department visits through on-going member education, care management and collaboration with IDT members.
  • Provides input and recommendations for design and development of, processes and procedures for effective member case management, efficient department operations, and excellent customer service.
  • Maintains accurate record of all care management. Maintains written progress notes and verbal communications according to program guidelines.
  • Participates in approval for out-of-network services when member receives services outside of VNS Health network services.
  • Provides case direction and assistance ensuring quality and appropriate service delivery.
  • Keeps current with all health plan changes and updates through on-going training, coaching and educational materials.
  • Provides clinical and programmatic support the to the ETE grant project.
  • Coordinates and participates in ETE conference calls with designated AIDS Centers (DAC) sites. Participates in weekly outreach team case conferences.

Coordinates sharing of information between subcontractor Community Based Organizations (CBOs), DAC, and internal staff at VNS Health.

Participates in special projects and performs other duties as assigned.

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
  • For SelectHealth ETE Only : Nurse Practitioner (NP) certification with background or degree in Public Health 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. preferred
  • Knowledge of Medicare and Medicaid regulations required
  • Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills.
  • Working knowledge of Microsoft Excel, Power-Point, and Word and strong typing skills required
  • Knowledge of Medicaid and / or Medicare regulations required
  • Knowledge of Milliman criteria (MCG) preferred
  • For SelectHealth ETE Only : Experience in Public Health programming, delivery and evaluation preferred
  • Experience working with community-based organizations in underserved communities preferred

VNS Health Job ID #R011531. Posted job title : Sh Rn Rn Care Manager

About VNS Health

VNS Health is one of the nation's largest nonprofit home and community-based health care organizations. Innovating in health care for more than 125 years, our commitment to health and well-being is what drives us we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community.

On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24 / 7 solutions and resources to the more than 43,000 neighbors who look to us for care.

Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of those we serve in New York and beyond.

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
  • 1 day ago
Related jobs
Promoted
Montefiore Medical Center
Edgewater, New Jersey

Montefiore Medical Center is seeking a Registered Nurse (RN) ICU - Intensive Care Unit for a nursing job in Edgewater, New Jersey. Supervises nursing attendants and ancillary staff in patient care activities. The Registered Nurse actualizes the vision, mission, values, balanced scorecard performance...

Promoted
Davita Kidney Care
Englewood Cliffs, New Jersey

Davita Kidney Care is seeking a Registered Nurse (RN) Dialysis for a nursing job in Englewood Cliffs, New Jersey. Support for you and your family: family resources, EAP counseling sessions, access Headspace®, backup child and elder care, maternity/paternity leave, pet insurance, and more. DaVita is ...

Promoted
ChristianaCare
Newark, New Jersey

ChristianaCare seeks an experienced Nurse Manager (RN) to assume 24-hour accountability and responsibility for excellence in the clinical and operational practice of nursing and the delivery of care in the Clinical Express Admission Department at Christiana Hospital. ChristianaCare is seeking a Regi...

Promoted
Montefiore Medical Center
Englewood Cliffs, New Jersey

Montefiore Medical Center is seeking a Registered Nurse (RN) Clinical Coordinator, ED - Emergency Department for a nursing job in Englewood Cliffs, New Jersey. The Patient Care Coordinator participates in performance improvement/research activities; maintains professional practice standards and clin...

Promoted
Montefiore Medical Center
Englewood Cliffs, New Jersey

Montefiore Medical Center is seeking a Registered Nurse (RN) ICU - Intensive Care Unit for a nursing job in Englewood Cliffs, New Jersey. Staff RN I/II and Registered Nurse – WF. The Registered Nurse actualizes the vision, mission, values, balanced scorecard performance measures for Montefiore Medic...

Promoted
VNS Health
Fairview, New Jersey

Minimum of two years in a clinical background as a Registered Nurse required Home care experience in a licensed home care service agency or CHHA settings preferred. VNS Health is seeking a Registered Nurse (RN) Skilled Nursing for a nursing job in Fairview, New Jersey. Provides case management suppo...

Promoted
Davita Kidney Care
Edgewater, New Jersey

Davita Kidney Care is seeking a Registered Nurse (RN) Dialysis for a nursing job in Edgewater, New Jersey. Support for you and your family: family resources, EAP counseling sessions, access Headspace®, backup child and elder care, maternity/paternity leave, pet insurance, and more. DaVita is a clini...

Promoted
Montefiore Medical Center
Englewood Cliffs, New Jersey

At least 2 years of ED RN experience is required New York State License for Registered Professional Nurse and current registration or valid permit to practice in New York State as an R. Montefiore Medical Center is seeking a Registered Nurse (RN) ED - Emergency Department for a nursing job in Englew...

Promoted
RWJ Barnabas
Newark, New Jersey

Qualifications:Required:* ASN or Nursing Diploma* Graduate of an accredited Nursing Program* BLS Heart Saver/Health Care Provider* Strong communication and organizational skills* Proficient computer skillsPreferred:* BSN* Minimum 1 year of hospital experience* ACLS within 90 days of hireCertificatio...

VNA Health Group
Cedar Grove, New Jersey

The RN is a professional nurse whose primary role is to function independently in providing comprehensive end of life care to patients/family units who are currently experiencing a terminal illness. VNA Health Group is seeking a Registered Nurse (RN) Home Health Hospice for a nursing job in Cedar Gr...