Clinical Care Manager, RN
Company: VNS Health
Location: Little Ferry
Posted on: April 20, 2024
Job Description:
OverviewProvides 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
- 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
- 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.QualificationsLicenses and Certifications:
- License and current registration to practice as a Registered
Professional Nurse in NYS required
- Population Care Coordination certification preferred
- Care Management, Case Management, OASIS or other applicable
certification preferredEducation:
- Associate's Degree in nursing required
- Bachelor's Degree in nursing preferredWork Experience:
- Minimum two years of experience as a registered nurse
required
- Care management and/or managed care experience preferred
- Proficiency in Microsoft Office applications required
- Demonstrated analytical skills required
Keywords: VNS Health, Hackensack , Clinical Care Manager, RN, Healthcare , Little Ferry, New Jersey
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