Clinical Care Manager, RN

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.

$93,400.00 - $116,800.00 Annual

What 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.

Licenses 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 preferred

Education:

• Associate's Degree in nursing required

• Bachelor's Degree in nursing preferred

Work 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