Clinical Evaluation Manager, Care Manager, HIV Plan, Brooklyn 10/8/2017
Visiting Nurse Service Of New York
JOB DESCRIPTIONAPPLY OVERVIEW
Created in 1998, VNSNY CHOICE is the managed care affiliate of the Visiting Nurse Service of New York and shares its mission of compassion and care for the poor, the chronically ill and elderly. Our guiding principle is to help the most vulnerable among us live safely and independently for as long as possible in their own homes and communities. VNSNY CHOICE has 700 employees, including 227 care management staff. On any given day, VNSNY CHOICE coordinates care for more than 40,000 members through its array of Medicare and Medicaid health plans, including Medicaid Long Term Care, Medicare Advantage, and a HIV/Special Needs Plan. With offices in Manhattan, Brooklyn and upstate New York, VNSNY CHOICE health plans are available in the New York City metropolitan area as well as on a plan basis in selected counties throughout New York State.
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: