Clinical Evaluation Manager: Care Optimization

VNS Health; New York (NY); On-site; USD 85,000 - 106,000; Full time

Benefits offered by this job

Referral bonus

PTO 30 days + 9 holidays

Health insurance for you and family

Employer-matched retirement savings

Tuition reimbursement

Professional growth opportunities

Internal mobility

CEU credits

Job summary

VNS Health in New York is seeking an experienced Registered Nurse for utilization review and care coordination. You will assess requests, ensure medical necessity, and coordinate with physicians and care teams to promote cost-effective, high-quality care.

The role emphasizes prior authorizations, discharge planning, and adherence to state and federal regulations while supporting member education and collaboration across the care continuum.

Qualifications

• Knowledge of Medicare and Medicaid regulations.
• Experience in cost containment and case management.
• Excellent organizational and time management skills.

Responsibilities

• Conducts comprehensive review of requests for services with clinical record review and interviews.
• Assesses medical necessity and appropriateness of admissions and treatments.
• Performs prior authorization and concurrent reviews to ensure appropriateness and setting.
• Participates in case conferences and collaborates with management and IDT.
• Provides input for care plans and safe discharge with community transition.
• Maintains accurate clinical records and progress notes.

Skills

Cost containment

Case management

Organizational skills

Communication skills

Medicare/Medicaid knowledge

Education

Associate's Degree in Nursing

Bachelor's/Master's in Nursing

Tools

Microsoft Excel

PowerPoint

Microsoft Word

Job description

VNS Health in New York is seeking an experienced Registered Nurse for utilization review and care coordination. You will assess requests, ensure medical necessity, and coordinate with physicians and care teams to promote cost-effective, high-quality care.

The role emphasizes prior authorizations, discharge planning, and adherence to state and federal regulations while supporting member education and collaboration across the care continuum.