Utilization Management RN: Elevate Care & Cost Efficiency

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

Benefits offered by this job

Referral bonuses

PTO 30+9 holidays

Health insurance

Retirement plan

Tuition reimbursement

Career advancement

Internal mobility

Job summary

VNS Health in New York provides patient-centered and cost-effective care coordination and utilization management for members. The role focuses on reviews, approvals, and discharge planning in accordance with state and federal regulations.

We require an active NY RN license with 2+ years in case management or acute inpatient settings, plus familiarity with Medicare/Medicaid guidelines. Don’t miss the opportunity to contribute to improving patient outcomes and operational efficiency.

Qualifications

• Current license to practice as a Registered Nurse in New York State required.
• Two years of experience with strong cost containment / case management background or two years acute inpatient hospital experience in chronic or complex care required.
• Knowledge of Medicare and Medicaid regulations required; Milliman criteria (MCG) preferred.

Responsibilities

• Conducts comprehensive review of all components related to requests for services including clinical record review and interviews with members and care providers.
• Performs prior authorization and concurrent reviews to ensure medical necessity and appropriate setting of care.
• Ensures compliance with state and federal regulatory standards and VNS Health policies and procedures.
• Participates in case conferences with management.
• Maintains accurate record of all care management and writes progress notes as per guidelines.

Skills

Registered Nurse

Care management

Cost containment

Education

Associate's Degree in Nursing

Bachelor's or Master's in nursing preferred

Tools

Microsoft Excel

Job description

VNS Health in New York provides patient-centered and cost-effective care coordination and utilization management for members. The role focuses on reviews, approvals, and discharge planning in accordance with state and federal regulations.

We require an active NY RN license with 2+ years in case management or acute inpatient settings, plus familiarity with Medicare/Medicaid guidelines. Don’t miss the opportunity to contribute to improving patient outcomes and operational efficiency.