Clinical Care Manager, Registered Nurse, Chronic Care Management (Mostly Remote)

Visiting Nurse Service of New York • New York, NY

87d • $93,400 - $116,800

About The Position

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.

Requirements

• License and current registration to practice as a Registered Professional Nurse in NYS required.
• Certified Case Manager - Commission for Case Manager Certification within 1 year of employment required.
• Associate's Degree in nursing required.
• Bachelor's Degree in nursing preferred.
• Minimum two years of experience in health related field required.
• Care management and/or managed care experience preferred.
• Proficiency in Microsoft Office applications required.
• Demonstrated analytical skills required.

Responsibilities

• 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.

Benefits

• 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 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.
• Referral bonus opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Associate degree