Clinical Evaluation & Utilization Manager

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

Benefits offered by this job

Referral bonus opportunities

Paid time off 30 days+

Health insurance for you and family

Employer-matched retirement savings

Tuition reimbursement

Professional growth opportunities

Pre-tax FSAs

Job summary

VNS Health seeks a qualified nurse to assess member needs, authorize services, and coordinate care management within regulatory guidelines. You will work with medical teams to ensure appropriate, timely, cost-effective care and discharge planning.

Requirements include an NY RN license, preferred CM certification, and 2 years in cost containment or acute inpatient settings. Strong organizational and communication skills are essential for success.

Qualifications

• Current license to practice as a Registered Professional Nurse in New York State.
• Certified Case Manager preferred.
• Two years of cost containment / case management experience or two years acute inpatient hospital experience.
• Knowledge of Medicare/Medicaid regulations; LTSS preferred.
• Strong organizational and time management, verbal and written communication skills.

Responsibilities

• Reviews treatment requests with clinical records and interviews to determine medical necessity.
• Performs prior authorization and concurrent reviews to ensure appropriate care setting.
• Communicates determinations and coordinates with care teams for discharge planning.
• Maintains documentation, plans, and opportunities for process improvements in care management.

Skills

Interpersonal skills

Communication skills

Time management

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Tools

Microsoft Excel

PowerPoint

Word

Job description

VNS Health seeks a qualified nurse to assess member needs, authorize services, and coordinate care management within regulatory guidelines. You will work with medical teams to ensure appropriate, timely, cost-effective care and discharge planning.

Requirements include an NY RN license, preferred CM certification, and 2 years in cost containment or acute inpatient settings. Strong organizational and communication skills are essential for success.