The Visiting Nurse Service of New York (VNSNY) is the nation's largest not-for-profit home- and community-based health care organization, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Counties. For 125 years, VNSNY has been committed to meeting the health care needs of New Yorkers with compassionate, high-quality home health care. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, members, and clients from before birth to the end of life.
Each day, more than 13,000 VNSNY employees - including nurses, rehabilitation therapists, social workers, other allied professionals, and paraprofessionals - deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 48,000 patients and members, helping them to live the best lives possible in their homes and communities.
Responsibilities and Qualifications
Assesses member needs and identifies solutions that promote high quality and cost effective health care services. Manages requests for services from providers, members, and care management team and renders clinical determinations in accordance with VNSNY CHOICE policies as well as applicable state and federal regulations. Delivers timely notification detailing VNSNY CHOICE clinical decisions. Coordinates with VNSNY CHOICE team, subject matter experts, physicians, member representatives, and discharge planners 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 or care management experience at a Managed Care Organization or Health Plan preferred. Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills required. Demonstrated strong relationship management skills, including a high degree of psychological sophistication and non-aggressive assertiveness required. Demonstrated successful conflict management skills and negotiation of win-win solutions required. Working knowledge of Microsoft Excel, Power-Point, and Word required. Knowledge of Medicaid and/or Medicare regulations required. Knowledge of Milliman criteria (MCG) preferred.