Leads the Inter-Disciplinary Team (IDT) which provides each participant with an individualized, comprehensive care plan designed to maximize and maintain individual's functional potential and quality of life. Authorizes and manages the clinical and customer service decisions relating to the case management and services provided to health plan participants. Provides telephonic case management to members. Ensures all services provided are in compliance with VNSNY CHOICE health plan policies and procedures as well as applicable state and federal regulations, while at the same time balancing clinical and customer service concerns. Works under general supervision. Licensure: Current registration to practice as a Licensed social worker in New York State required. Valid driver's license or NYS Non-Driver photo ID card, may be required as determined by operational/regional needs. Education: Master's degree in Social Work after successfully completing a prescribed course of study at a graduate school of Social Work accredited by the Council on Social Work Education and the Education Department required. Experience: Minimum of three years of experience in a managed care organization working with Medicare and Medicaid guidelines, including familiarity with Medicare Part A, B, and D, required. Prior experience working with regulators, medical, behavioral health and social service providers and all levels of staff to care manage and coordinate services required. Demonstrated understanding of a fully capitated program from a regulatory perspective for care management and the ability to apply capitation to care management practice required. WFamiliarity with NY State assessment tools (UAS, SAMM, PRI, DSM-1, etc.) preferred. Experience in utilization review with strong cost containment/case management background preferred. Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills and computer skills required. Must have experience and qualifications reflective of needs of members Population (i.e., communication, cognitive, or other barriers); and knowledge of physical health, aging and loss, appropriate support services in the community, frequently used medications and their potential negative side-effects, depression, challenging behaviors, Alzheimer's disease and other disease-related dementias, behavioral health and issues related to accessing and using durable medical equipment, as appropriate.
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 Countries. For over 125 years, VNSNY has been committed to improving the health and well-being of people through high-quality, cost effective healthcare in the home and community. 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 44,000 patients and members, helping them to live the best lives possible in their homes and communities.