VNS Health

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.. Makes timely telephonic care management calls based on risk level.. 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.. License and current registration to practice as a Registered Professional Nurse in NYS required. Care Management, Case Management, OASIS or other applicable certification preferred

clinical care manager

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. Compensation: $93,400.00 - $116,800.00 AnnualWhat We Provide<ul><li>Referral bonus opportunities   </li><li>Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays </li><li>Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability  </li><li>Employer-matched retirement saving funds </li><li>Personal and financial wellness programs  </li><li>Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care   </li><li>Generous tuition reimbursement for qualifying degrees </li><li>Opportunities for professional growth and career advancement  </li><li>Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities   </li></ul>What You Will Do<ul><li>Coordinates and/or oversees the coordination of benefits and services for all members on his/her caseload.</li><li>Completes care management and disease specific assessments.</li><li>Makes timely telephonic care management calls based on risk level.</li><li>Resolves and coordinates complex issues and member complaints impacting the delivery of services.</li><li>Provides health education to member/caregiver.</li><li>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.</li><li>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.</li><li>Coordinates the delivery of high quality, cost-effective care based on a customized population model of care supported by evidence based clinical practice guidelines.</li><li>Advocates for the member/caregiver to obtain the health care and other services needed to optimize their quality of life.</li><li>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.</li><li>Promotes adherence to the physician treatment plan by providing education, coaching and support.</li><li>Educates, coordinates, and provides resources to reduce inappropriate utilization of emergency room (ER) and hospital service.</li><li>Increases utilization of primary care, specialty care, preventive health and guideline-based treatments including proper pharmacotherapy within network, as appropriate.</li><li>Participates in interdisciplinary team (IDT) meetings and provide input on customer service-related activities.</li><li>Protects the confidentiality of member information and adheres to company policies regarding confidentiality.</li><li>Ensures compliance with payors’ policies and procedures as well as all Federal and State regulations.</li><li>Interprets and implements VNS Health policies, state and federal regulations.</li><li>Participates in special projects and performs other duties as assigned.</li></ul> Qualifications Licenses and Certifications:<ul><li>License and current registration to practice as a Registered Professional Nurse in NYS required</li><li>Population Care Coordination certification preferred</li><li>Care Management, Case Management, OASIS or other applicable certification preferred</li></ul> Education: <ul><li>Associate's Degree in nursing required</li><li>Bachelor's Degree in nursing preferred</li></ul> Work Experience:<ul><li>Minimum two years of experience as a registered nurse required</li><li>Care management and/or managed care experience preferred</li><li>Proficiency in Microsoft Office applications required</li><li>Demonstrated analytical skills required</li></ul>

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