Overview Assesses member needs and identifies solutions that promote high quality and cost-effective health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state and federal regulations. Delivers timely notification detailing clinical decisions. Coordinates with management, subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is appropriate, timely and cost effective. Works under general supervision. What We Provide Referral bonus opportunities Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability Employer-matched retirement saving funds Personal and financial wellness programs Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care Generous tuition reimbursement for qualifying degrees Opportunities for professional growth and career advancement Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities What You Will Do Conducts comprehensive review of all components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical providers, paraprofessional staff, caregivers and other relevant sources as necessary. Examines standards and criteria to ensure medical necessity and appropriateness of admissions, treatment, level of care and lengths of stay. Performs prior authorization and concurrent reviews to ensure extended treatment is medically necessary and being conducted in the right setting. Reviews requests for outpatient and inpatient admission; approves services or consults with medical directors when case does not meet medical necessity criteria. Ensures compliance with state and federal regulatory standards and VNS Health policies and procedures. Participates in case conferences with management. Identifies opportunities for alternative care options and contributes to the development of patient focused plan of care to facilitate a safe discharge and transition back into the community after hospitalization. Reviews covered and coordinated services in accordance with established plan benefits, application of evidenced based medical criteria, and regulatory requirements to ensure appropriate authorization of services and execution of the plan’s fiduciary responsibilities. Identifies and provides recommendations for improvement regarding department processes and procedures. Maintains current knowledge of organizational or state-wide trends that affect member eligibility and the need for issuance of Determination Notices Improves clinical and cost-effective outcomes such as reduction of hospital admissions and emergency department visits through on-going member education, care management and collaboration with IDT members. Provides input and recommendations for design and development of, processes and procedures for effective member case management, efficient department operations, and excellent customer service. Maintains accurate record of all care management. Maintains written progress notes and verbal communications according to program guidelines. Participates in approval for out-of-network services when member receives services outside of VNS Health network services. Provides case direction and assistance ensuring quality and appropriate service delivery. Keeps current with all health plan changes and updates through on-going training, coaching and educational materials. For Care Management Only: Assesses, plans, facilitates and advocates for options and services to effectively manage an individual’s health needs. Promotes quality and cost-effective outcomes at all times. Provides telephonic case management to members, balancing clinical, social, and environmental concerns. Provides analysis of initial health evaluation and comprehensive assessment of the member/family psychosocial status and case management needs. Participates in the development, coordination and implementation of the care plan to address specific needs of the member/family including thorough transitions between settings of care. Coordinates with community providers to ensure efficient and effective transitions and delivery of care in the home and community. Consults with the member, family, and members of the inter-disciplinary team to coordinate the treatment plan, education, self-care techniques and prevention strategies. Verifies that all aspects of the clinical record are in agreement with the member’s clinical and functional status. Utilizes VNS Health and state approved assessment and documentation as well as interviews with members, family, and care providers in decision-making. Performs annual clinical co-visits for nurses as well as two initial co-visits during the first six months for new hires as follows: one within first three weeks and a second within the first six months. Provides feedback to therapist and management; assists in development of plans to address improvement needs as appropriate. Participates in special projects and performs other duties as assigned. Qualifications Licenses and Certifications: Current license to practice as a Registered Professional Nurse or an Occupational Therapist in New York State required Certified Case Manager preferred Education: Associate's Degree in Nursing or a Master’s degree in Occupational Therapy required Bachelor's Degree or Master’s degree in nursing preferred Work Experience: Minimum two years of experience with strong cost containment /case management background or two years acute inpatient hospital experience in chronic or complex care required Must have experience and qualifications demonstrating knowledge of working with the LTSS eligible population. preferred Knowledge of Medicare and Medicaid regulations required Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills. Working knowledge of Microsoft Excel, Power-Point, and Word and strong typing skills required Knowledge of Medicaid and/or Medicare regulations required Knowledge of Milliman criteria (MCG) preferred Pay Range USD $85,000.00 - USD $106,300.00 /Yr. About Us VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.
Administrative Assistant needed in the Bronx PART TIME School setting, M-F 7:30am-2:30pm! SUMMARY Under general supervision, is responsible for providing clerical and secretarial support to the Program Director and other members of his/her staff. Provides guidance to Administrative Assistants I and II in the department. ESSENTIAL DUTIES AND RESPONSIBILITIES The incumbent in the position will perform all or some of the job duties that are listed below: • Greets visitors, ascertains their needs and directs them accordingly. • Answers telephone and screens calls for Program Director and/or other department staff. • Works cooperatively with other Administrative Assistants on joint assignments. • Interacts respectfully with persons receiving services encountered in course of work activities. • Relays information as necessary from and to bus drivers and/or transportation liaison. • Directs all important situations, inquiries and questions to supervisor. • Types records, reports, correspondence, etc. • Types requisitions for Purchase Orders, tracks delivery of items and forwards packing slips or receiving reports to Purchasing Department. • Orders and maintains adequate inventory of office supplies. • Receives, opens, sorts and distributes in-coming mail and packages. • Records attendance for persons served on monthly calendar for billing purposes. • Keeps track of staff attendance, vacations and sick leave and verifies accuracy of Time and Attendance forms. • Maintains a filing system of administrative and program materials and keeps files current. • Performs photocopying as needed. • Reimburses staff for approved petty cash expenditures, maintains accurate petty cash records and arranges for replenishment as required. • Sets up coffee and other refreshments for meetings as requested. • Takes direction from Administrative Assistant IV if there is one in department. Provides work assignments, guidance and instructions to Administrative Assistant I and II. • Performs other related duties as requested. Special Requirement Candidates for this position must be fingerprinted by the DOE. Fingerprint costs to be paid by the candidate. Fingerprinting will not need to be done unless candidate is onboarded for position. Salary: $20.00 per hour. For more information, or to schedule an interview, please contact: Howard Newman Account Manager, Bond Health Staffing 5824 12th Avenue Brooklyn, NY, 11219 Office: 1-718-302-0040 ext. 204 Fax: 1-718-302-0070 Howard@bondhealthstaffing.com
