Compensation: $83,450.00 - $117,470.00 /year *
Employment Type: Full-Time
Industry: Healthcare - Nursing
OVERVIEW 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 Partial remote schedule (1 - 2 day/week) after 6 month probationary period. RESPONSIBILITIES Authorizes and oversees visits per episode for the optimal utilization that results in the best possible clinical outcomes and efficient use of resources. Works directly with the patient, via various forms of communication, texting, virtual visits, and telephone, to achieve patient stated goals. Analyzes utilization to ensure visits are made according to episode utilization guidelines and clinical outcomes best practices. Develops/revises utilization policies and practices based on analysis of past practices to improve utilization. Applies clinical experience and judgment to the utilization management/care management activities. Addresses payor authorizations/reauthorizations within established time frames which includes, but is not limited to, reviewing clinical reports of providers for relevant patient data, communicating patient condition to payor case manager in a manner that is focused and reflects knowledge/understanding of patient condition/progress, and negotiating authorizations consistent with clinical data. Ensures appropriate utilization of home health care and other resources for optimal, cost effective care and services by reviewing clinical reports, DME/supply requisitions, and visit threshold reports. Establishes on-going dialogue with payor case managers and provider disciplines (e.g., nurses, physical therapist, occupational therapist, speech therapy, social worker). Handles managed care escalated clinical authorizations and denials. Directs field staff to take actions that address issues and improve performance, including changing plans of care and notifies payor case manager of significant changes in patient condition. Evaluates performance and reports assessments to clinical management and works with them to set accountability mechanisms and long-term correction standards. Develops, updates, and teaches curriculum, exercises and learning materials for clinicians in conjunction with the Learning & Development and Quality departments to improve on utilization management. Educates clinicians to follow best practices in utilization management/care management activities. Identifies areas of concern and works with Education department to revise courses as needed. Develops and assigns training activities in conjunction with the Learning & Development and Quality departments, based on individual clinicians learning needs and capabilities. Provides direction to staff and Clinical Field Manager, via telephone in response to any situations arising in the field with regard to visit and patient care planning. Provides coaching, education, performance evaluation assessments, and counseling and discipline, as needed, to clinicians regarding job performance. Maintains complete and timely documentation of assessment and performance management activity and clinician prog
Associated topics: ambulatory, coronary, intensive, maternal, mhb, nurse, recovery, registered nurse, staff nurse, surgery
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.
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