Visiting Nurse Service of New York (VNSNY) is the nation’s largest not-for-profit community-based health system. VNSNY provides a comprehensive array of home- and community-based programs, including health plans, tailored to the needs of high-risk, vulnerable New Yorkers, improving their quality of life. Each day, more than 18,000 VNSNY employees — including nurses, rehabilitation therapists, social workers, dieticians, other allied professionals, and paraprofessionals — deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 35,000 patients, helping them to live the best lives possible.
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 and Qualifications:
Assists General Manager in planning, directing and coordinating all medical and related activities for CHOICE Health Plans. Participates in implementing standards of medical service and advises General Manager on medical and administrative questions and policies as they relate to the CHOICE population. Plans for and participates in physician education. Investigates and implements new medical and clinical practices and techniques. Serves as consultant for unusual and difficult medical cases. Actively participates in the QARR/HEDIS Quality Improvement Activities and utilization management of the population. Works under limited supervision.
- Assists in the supervision of medical operations to ensure high quality and cost effective medically necessary services, along with ongoing care management, are provdied by assigned staff based on medical standards while abiding with contract relationships in home, community and facility-based setting within a capitated reimbusement rated.
-Participates in establishing medical policies; designs and implements advanced care/case management strategies, and communicates, as needed, with providers to ensure effective quality care is being provided.
-Reviews care/case management reports and identifies trends and needs of the program population; collaborates with Medical Management leadership to develop and implement plans to meet needs.
- Provides guidance and consultative services to Utilization Management (UM) and Care Management (CM) staff on issues relating to clinical services, case management, condition management, and health risk assessments. Develops solutions for complex cases, reviews prior authorizations/denial of services, and grievances and appeals. Participates in weekly care management/UM rounds.
Licensure: Licensed to practice medicine in New York State required. Board Certification required. Certification in Geriatric Care preferred. Valid driver's license or NYS Non-Driver photo ID card, may be required as determined by operational/regional needs.
Experience: Minimum five years of experience in clinical medicine, including geriatrics or HIV population, required. Minimum three years of medical management experience required. Administrative and/or management experience required. Managed care experience preferred.