Clinical Evaluation & Utilization Lead

VNS Health; New York (NY); On-site; USD 85,000 - 106,300; Full time

Benefits offered by this job

Referral bonus opportunities

Generous paid time off (PTO)

Health insurance plan

Employer-matched retirement saving funds

Tuition reimbursement for qualifying degrees

Job summary

VNS Health is looking for a Registered Professional Nurse or Occupational Therapist in New York to assess member needs and provide high-quality health care services. The role includes managing requests for medical services, ensuring compliance with regulations, and improving clinical outcomes.

The ideal candidate will have an Associate's Degree in Nursing or a Master’s degree in Occupational Therapy, with a robust background in case management and knowledge of related regulations. Competitive compensation and benefits are provided.

Qualifications

• Current license to practice as a Registered Professional Nurse or an Occupational Therapist in New York State required.
• Certified Case Manager preferred.
• Minimum two years of experience with strong cost containment/case management background required.

Responsibilities

• Conduct comprehensive review of all components related to requests for services.
• Ensure compliance with state and federal regulatory standards.
• Participate in case conferences with management.

Skills

Organizational skills

Verbal communication

Written communication

Knowledge of Medicare and Medicaid regulations

Experience with LTSS eligible population

Education

Associate's Degree in Nursing

Master’s degree in Occupational Therapy

Tools

Microsoft Excel

Microsoft PowerPoint

Microsoft Word

Job description

VNS Health is looking for a Registered Professional Nurse or Occupational Therapist in New York to assess member needs and provide high-quality health care services. The role includes managing requests for medical services, ensuring compliance with regulations, and improving clinical outcomes.

The ideal candidate will have an Associate's Degree in Nursing or a Master’s degree in Occupational Therapy, with a robust background in case management and knowledge of related regulations. Competitive compensation and benefits are provided.