Clinical Care Manager RN -mostly remote
Manhattan, New York Care Management
Apply Now Job ID R010517 Overview
Our clinical care management services are anchored in evidence-based practices to optimize the utilization of healthcare benefits and services.
We are dedicated to delivering personalized care that empowers patients to safely manage their health within the comfort and security of their own homes and communities.
Compensation :
$93,400.00 - $116,800.00 Annual
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
Personal and financial wellness programs
Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care and commuter transit program
Generous tuition reimbursement for qualifying degrees
Opportunities for professional growth and career advancement
Internal mobility, CEU credits, and advancement 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.
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.
Qualifications
- 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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