Care Manager, Health Plan, RN required
Visiting Nurse Service of New York (VNSNY) is the nation s largest not-for-profit community-based health system. VNSNY provides a comprehensive array of home- and community-based programs, including health plans, tailored to the needs of high-risk, vulnerable New Yorkers, improving their quality of life. Each day, more than 18,000 VNSNY employees including nurses, rehabilitation therapists, social workers, dieticians, other allied professionals, and paraprofessionals deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 35,000 patients, helping them to live the best lives possible.
RESPONSIBILITIES AND QUALIFICATIONS:
Improves clinical and cost-effective outcomes by reducing hospital admission and emergency department visits for members enrolled in VNSNY CHOICE Medicare and Medicaid, through on-going member education, care coordination and collaboration with providers of care. Provides telephonic case management to members, balancing clinical, social, and environmental concerns. Ensures services provided are in compliance with VNSNY CHOICE Medicare and Medicaid policies and procedures, as well as applicable state and federal regulations. Works under general supervision.
Licensure: License and current registration to practice as a registered professional nurse in New York State required. Certified Case Manager Certification preferred.
Education: Bachelor's or Master's Degree in Nursing preferred.
Experience: Minimum of two years of experience in a managed care organization or health plan, preferably in utilization review with cost containment/case management, required. Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills required. Working knowledge of Microsoft Excel, Power-Point, and Word required. Knowledge of Medicare/Medicaid and/or commercial regulations required. Knowledge of Milliman criteria (MCG) preferred. Bilingual skills preferred.
VNSNY is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, national origin, disability or protected veteran status. If you would like more information about your EEO rights, then please visit: