Nursing Jobs in Demarest, NJ
$85,000 - $106,300 / year
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. 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 in New York State required Certified Case Manager preferred Education: Associate's Degree in Nursing 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 has been committed to meeting the needs of New Yorkers for over 130 years. We’re one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day. 
$95,000 - $105,000 / year
UAS RN Assessor Located in Staten Island, NY Salary: starting at $95K - $105K; Based on prior experience Qualifications : Experience in assisted living or long-term care settings is preferred. UAS (Uniform Assessment System) experience is required. Must have a valid New York RN License Strong leadership, communication, and organizational skills. Ability to work collaboratively within a healthcare team. Responsibilities : Assist the Director of Nursing with day-to-day administrative tasks. Supervise and support the nursing staff to ensure quality care. Maintain accurate and up-to-date medical records and documentation. Coordinate care plans and participate in resident assessments. Support compliance with state regulations and facility policies. Communicate effectively with residents, families, and healthcare teams. Address any healthcare-related issues promptly and professionally. #7140 
$72,976.04 - $73,299.95 / year
NYU Langone Hospital—Long Island is a 591-bed university-affiliated medical center, which offers sophisticated diagnostic and therapeutic care in virtually every specialty and subspecialty of medicine and surgery. We are a major regional healthcare resource with a deep commitment to medical education and research, offering a full complement of inpatient and outpatient services. At NYU Langone Health, equity and inclusion are fundamental values. We strive to be a place where our exceptionally talented faculty, staff, and students of all identities can thrive. We embrace inclusion and individual skills, ideas, and knowledge. Learn more about NYU Langone Hospital—Long Island , and interact with us on LinkedIn , Glassdoor , Indeed , Facebook , X , YouTube and Instagram . Position Summary: We have an exciting opportunity to join our team as a Licensed Practical Nurse - Multispeciality - Garden City. In this role, the successful candidate Provide care and treatment to patients and clinical and technical support to professional medical staff. Utilize clinical expertise to deliver safe, therapeutic, age-specific patient care through planning, implementation and evaluation. Works collaboratively with a multidisciplinaryHealth team to promote wellness and optimize patient outcomes. Perform phlebotomies and administer subcutaneous and intramuscular injections (SQ/IM). Job Responsibilities: Performs other duties as assigned Evaluate the health care of patientsfamilies and respond to care rendered. Make appropriate referrals, under the direction of the RNNPMD. Access and document patients response to nursing and interdisciplinary team interventions. Evaluate patients clinical status and report findings to the RNNPMD and address patient issues following established communication hierarchy. Participate in problem identification and problem solving in the work environment. Contribute to the growth and development of self, staff and students through participation in peer review, mentor relationships, formal and informal education. Ensure completion of patient care assignment in an organized and efficient manner. Delegate aspects of patient care to team members consistent with scope, capabilities and responsibilities of care giver and supervise completion of assigned tasks. Establish therapeutic relationship with patientfamily. Communicate directly and effectively with patients regarding their care or treatment using appropriate terminology and in a respectful manner. Interact with medical and support staff efficiently and professionally. Use proper patient education techniques. Minimum Qualifications: To qualify you must have a High School or GED required. Graduate of LPN program Current New York State Licensed Practical Nurse License and Registration. Basic computer skills. Good communication skills. Strong attention to details, accuracy and ability to multitask and set priorities.. Required Licenses: LPN Preferred Qualifications: 1 - 2 Years experience in private practice Qualified candidates must be able to effectively communicate with all levels of the organization. NYU Langone Hospital—Long Island provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents. At NYU Langone Health, we are committed to supporting our workforce and their loved ones with a comprehensive benefits and wellness package. Our offerings provide a robust support system for any stage of life, whether it's developing your career, starting a family, or saving for retirement. The support employees receive goes beyond a standard benefit offering, where employees have access to financial security benefits, a generous time-off program and employee resources groups for peer support. Additionally, all employees have access to our holistic employee wellness program, which focuses on seven key areas of well-being: physical, mental, nutritional, sleep, social, financial, and preventive care. The benefits and wellness package is designed to allow you to focus on what truly matters. Join us and experience the extensive resources and services designed to enhance your overall quality of life for you and your family. NYU Langone Hospital—Long Island is an equal opportunity employer and committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration. We require applications to be completed online. View Know Your Rights: Workplace discrimination is illegal . NYU Langone Health provides a salary range to comply with the New York state Law on Salary Transparency in Job Advertisements. The salary range for the role is $72,976.04 - $73,299.95 Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits. To view the Pay Transparency Notice, please click here 
