Clinical Case Manager-Hybrid

Visiting Nurse Service of New York d/b/a VNS Health • New York, NY

6h • Hybrid

About The Position

The Clinical Manager provides clinical oversight, supervision, and operational support within the Personal Care department, primarily supporting Queens and Long Island. This role serves as a key clinical resource for authorization review, care coordination, documentation compliance, staff supervision, education, and escalation management across managed care, MLTC, private pay, and skilled cases.
The Clinical Manager acts as a liaison between field staff, internal teams, payors, providers, and VNS Health Care Managers to ensure the safe, compliant, and timely delivery of care. The position also participates in a rotating on-call weekend clinical triage schedule every 5–6 weeks.

Requirements

• Current NYS Registered Professional Nurse (RN) license required
• Associate’s Degree in Nursing required
• Minimum of three (3) years of professional nursing experience
• Strong clinical judgment and communication skills
• Ability to supervise and support clinical staff
• Proficiency in HHAX and Microsoft Office
• Ability to manage competing priorities and clinical escalations

Nice To Haves

• Bachelor’s Degree preferred
• Home care, case management, or supervisory experience preferred

Responsibilities

• Provide clinical guidance to the Authorization/Denials unit and support resolution of authorization escalations
• Review Start of Care and ongoing authorizations for completeness, accuracy, and clinical appropriateness
• Provide daily clinical triage support and participate in rotating on-call weekend coverage every 5–6 weeks
• Provide clinical oversight and supervision for 3–6 full-time Registered Nurse Field Supervisors (RNFS) and per diem staff
• Support RNFS onboarding, orientation, training, and shadowing
• Provide ongoing clinical guidance related to assessments, documentation, patient care concerns, and regulatory requirements
• Review clinical documentation in HHAX to ensure alignment across assessments, Plans of Care (POCs), PPOCs, 485s, visit frequencies, and clinical notes
• Investigate and resolve missing, unclear, or removed 485s and documentation discrepancies
• Review clinical visits and update visit statuses as needed
• Monitor master week reports to identify missing POCs and coordinate RNFS visits, interim orders, or POC revisions
• Complete DOH follow-ups, Risk Log reviews, discharge summary reviews, and audit follow-ups
• Collaborate with Quality Assurance on audits, chart reviews, and quality improvement initiatives
• Coordinate care with providers, payors, VNS Health Care Managers, and internal teams to ensure continuity of care
• Review and respond to Care Management and CHW assessment findings requiring clinical follow-up
• Conduct direct outreach to members and caregivers to address complaints, clinical concerns, and service issues
• Serve as a clinical escalation point for complex cases or member concerns beyond unit-level resolution
• Provide ongoing clinical education and real-time guidance to RNFS and field staff
• Participate in Home Health Aide education, reinforcing care plans, safety standards, documentation expectations, and reporting requirements
• Complete Monthly Education Reports for RN staff related to PPOC adherence, assessments, and 485 alignment
• Participate in case conferences, team meetings, and hiring interviews
• Maintain timely and professional email and internal communications
• Support RNFS payroll, PTO, leave tracking, and onboarding processes in HHAX
• Coordinate training logistics, equipment ordering, and scheduling for new and existing staff
• Support private pay intake processes, addressing missing documentation, credentialing issues, and SOC discrepancies
• Ensure private skilled cases have appropriate physician orders, supplies, and coordination prior to service initiation

Benefits

• 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 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 This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree