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Clinical Care Manager, RN

Company: VNS Health
Location: Bergenfield
Posted on: April 2, 2024

Job Description:

OverviewProvides 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 AnnualWhat 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.QualificationsLicenses 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 preferredEducation:
        • Associate's Degree in nursing required
        • Bachelor's Degree in nursing preferredWork 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

Keywords: VNS Health, Tenafly , Clinical Care Manager, RN, Healthcare , Bergenfield, New Jersey

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