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Posted: Monday, January 8, 2018 5:41 AM

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.

Responsibilities

Assesses member needs and identifies solutions that promote high quality and cost effective health care services.. Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in accordance with VNSNY CHOICE Health policies as well as applicable state and federal regulations. Delivers timely notification detailing VNSNY CHOICE clinical decisions. Coordinates with VNSNY CHOICE Care and Utilization management, subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is appropriate, timely and cost effective. Works under general supervision.

Licensure: Current license to practice as a Registered Professional Nurse in New York State required. Certified Case Manager preferred.

Education: Bachelor's degree or Master's degree in nursing preferred.

Experience: Minimum two years of utilization review experience at a Managed Care Organization or Health Plan required. Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills. Working knowledge of Microsoft Excel, Power-Point, and Word required. Knowledge of Medicaid and/or Medicare regulations required. Knowledge of Milliman criteria (MCG) preferred.

SDL2017


Associated topics: bsn, care, care unit, ccu, intensive, neonatal, nurse, nurse rn, staff nurse, unit

Source: http://www.jobs2careers.com/click.php?id=4677550721.96


• Location: Brooklyn

• Post ID: 153678887 newyork
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