Registered Nurse (RN) - Care Manager
VNS Health
Manhattan, NY

Clinical Care Manager, RN

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 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 * 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. Qualifications Licenses 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 preferred Education: * Associate's Degree in nursing required * Bachelor's Degree in nursing preferred Work 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