Nursing Jobs in Edison, 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 and 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. 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. For Utilization Management Only: Issues Determinations, Notices of Action, and other forms of communication to members and providers which communicate VNS Health’s determinations. Ensures all records/logs related to decision requests, Notices of Action, and other communications required by state or federal regulations are saved in the Utilization Management System. Reviews, evaluates and determines the appropriateness of requests, utilize the most appropriate clinical care guidelines based on clinical practice guidelines. Adheres to all federal and regulatory requirements. Evaluates and analyzes care and utilization trends/issues and identifies opportunities for better coordination of members’ care. 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 For UM Only: Experience must be with a Managed Care Organization or Health Plan. For SelectHealth ETE Only: Experience in Public Health programming, delivery and evaluation preferred Experience working with community-based organizations in underserved communities 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. 
Seeking Female CHHA to work with middle aged woman who needs assistance dressing, changing, washing etc.. M-F 10am-2pm Paying $21/hr Respond to mayahomecarenj@gmail.com Asap. 
$110,000 - $120,000 / year
Compliance Nurse – RN Location: Brooklyn, NY Schedule: Full-Time | Monday–Friday | 9:00 AM–5:00 PM Salary: $110,000–$120,000 per year Ditmas Park Nursing & Rehab is seeking an experienced Registered Nurse (RN) to serve as our Compliance Nurse . This is a full-time leadership-focused position responsible for overseeing nursing compliance and helping ensure the facility consistently meets regulatory requirements, internal policies, and standards of care. The Compliance Nurse will work closely with nursing leadership, administration, and clinical staff to identify compliance concerns, review documentation and processes, and make sure corrective measures are implemented when needed. Responsibilities include: Oversee nursing compliance throughout the facility Monitor adherence to federal, state, and facility regulations and policies Conduct audits of nursing documentation, clinical records, and care processes Identify compliance concerns and areas requiring improvement Develop and follow up on corrective action plans Assist with survey preparation and regulatory reviews Monitor ongoing compliance following surveys, audits, or identified deficiencies Educate and support nursing staff regarding policies, procedures, and regulatory requirements Work closely with the Director of Nursing and facility leadership to maintain high standards of care Review incidents, documentation, and clinical practices for potential compliance issues Maintain appropriate compliance records and reports Help ensure policies and procedures remain current and are consistently followed Qualifications: Current New York State RN license Nursing home, skilled nursing, or long-term care experience strongly preferred Experience with compliance, auditing, quality assurance, nursing administration, or regulatory processes preferred Strong understanding of nursing documentation and regulatory requirements Excellent organizational skills and attention to detail Ability to work independently while collaborating closely with nursing and administrative leadership Schedule & Compensation This is a full-time, Monday through Friday position, 9:00 AM–5:00 PM , with an annual salary of $110,000–$120,000 , based on experience. Ditmas Park Nursing & Rehab is looking for a knowledgeable and detail-oriented nurse who can take ownership of nursing compliance and help maintain strong clinical and regulatory standards throughout the facility. 
What You'll Be Doing The Registered Nurse (RN) is responsible for assessing, planning, implementing and evaluating the delivery of care. The RN assumes the responsibility and accountability for the delegation of patient care to other members of the health care team. As an integral member of the health care team, coordinates patient care and communicates and collaborates extensively with the other members of the healthcare team, patients and/or patient's family or significant other(s). Maintains and demonstrates high standards of professional ethics. What We're Looking Fo r Associate Degree in Nursing required. Bachelor’s degree (preferred) Valid NJ RN License required. BLS from AHA required. At least 2 years relevant work experience required. 2-4 years of relevant experience (preferred) Full-time, Night shift. 7pm to 7:30am Rotational weekend Saturday and Sunday. 
