Nursing Jobs in Highlands, 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. 
$85,000 - $106,300 / year
Overview Conducts and reviews UAS-NY comprehensive assessments of potential and existing members. Establishes an individual Plan Of Care based on members clinical, environmental, and social needs to support member safety in the community. Identifies solutions that promote high quality and cost-effective health care services in accordance with VNS Health Plans policies, state and federal regulations.. Manages requests for services from providers, members, and care management team. Works under general supervision. • Conduct face-to-face or telehealth UAS-NY assessments according to state guidelines, policies, procedures, and protocols. • Utilize clinical skills to assess and document all aspects of the potential members long-term community-based needs. • Communicate with members, families, providers, and other parties as needed to complete an accurate comprehensive assessment. • Utilizes VNS Health and state-approved assessment questionnaire, guidelines, and documentation as well as interviews with members, family, and care providers in decision-making. • Performs in-home assessment for members who have identified significant changes in condition since last in-home assessment; provides comprehensive review and determination of member’s needs, including completion of UAS assessment questionnaire, tasking tool, and a projected service plan. Visits include all areas serviced by VNS Health Plans including upstate and downstate counties. • Performs in-home assessment on members to determine the appropriate service plan, including completion of UAS assessment questionnaire, tasking tool, and a projected service plan. Visits include all areas serviced by VNS Health Plans. • Explains VNS Health Plan benefits, including an explanation of the member's handbook. • Ensures compliance with state and federal regulatory standards and VNS Health Plans policies and procedures. • Identifies opportunities for alternative care options and contributes to the development of a safe member centered service plan. • Consult with supervisor and others in overcoming barriers in meeting goals and objectives. • Maintains current knowledge of organizational and state-wide regulations that affect member eligibility. • Coordinates with other departments, e.g. Care Management, Legal Affairs, Grievance and Appeals, Compliance, Membership Eligibility Unit, Quality as needed. • Participates in requests for out-of-network services when a member receives services outside of VNS Health Plans network services. • Keeps current with all health plan changes and updates through on-going training, coaching and educational materials. • 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 Valid driver's license or NYS Non-Driver photo ID card required as determined by operational/regional needs required Education: Bachelor's Degree in nursing or similar field required Work Experience: Minimum two years of clinical assessment, homecare or hospital experience preferred Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills required Demonstrates strong relationship management skills, including a high degree of interpersonal communication l and non-aggressive assertiveness required Demonstrates successful conflict management skills and achieving “win-win” solutions required Working knowledge of Microsoft Suite Products e.g. Excel, Power-Point, Word required Knowledge of Medicaid and Medicare regulations required Working Knowledge of UAS-NY preferred Pay Range per Visit: If you are applying to the per diem per visit version of this job, the hiring range is as follows: $80 per visit. 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. $85,000 - $106,300 / year
Overview Conducts and reviews UAS-NY comprehensive assessments of potential and existing members. Establishes an individual Plan Of Care based on members clinical, environmental, and social needs to support member safety in the community. Identifies solutions that promote high quality and cost-effective health care services in accordance with VNS Health Plans policies, state and federal regulations.. Manages requests for services from providers, members, and care management team. Works under general supervision. • Conduct face-to-face or telehealth UAS-NY assessments according to state guidelines, policies, procedures, and protocols. • Utilize clinical skills to assess and document all aspects of the potential members long-term community-based needs. • Communicate with members, families, providers, and other parties as needed to complete an accurate comprehensive assessment. • Utilizes VNS Health and state-approved assessment questionnaire, guidelines, and documentation as well as interviews with members, family, and care providers in decision-making. • Performs in-home assessment for members who have identified significant changes in condition since last in-home assessment; provides comprehensive review and determination of member’s needs, including completion of UAS assessment questionnaire, tasking tool, and a projected service plan. Visits include all areas serviced by VNS Health Plans including upstate and downstate counties. • Performs in-home assessment on members to determine the appropriate service plan, including completion of UAS assessment questionnaire, tasking tool, and a projected service plan. Visits include all areas serviced by VNS Health Plans. • Explains VNS Health Plan benefits, including an explanation of the member's handbook. • Ensures compliance with state and federal regulatory standards and VNS Health Plans policies and procedures. • Identifies opportunities for alternative care options and contributes to the development of a safe member centered service plan. • Consult with supervisor and others in overcoming barriers in meeting goals and objectives. • Maintains current knowledge of organizational and state-wide regulations that affect member eligibility. • Coordinates with other departments, e.g. Care Management, Legal Affairs, Grievance and Appeals, Compliance, Membership Eligibility Unit, Quality as needed. • Participates in requests for out-of-network services when a member receives services outside of VNS Health Plans network services. • Keeps current with all health plan changes and updates through on-going training, coaching and educational materials. • 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 Valid driver's license or NYS Non-Driver photo ID card required as determined by operational/regional needs required Education: Bachelor's Degree in nursing or similar field required Work Experience: Minimum two years of clinical assessment, homecare or hospital experience preferred Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills required Demonstrates strong relationship management skills, including a high degree of interpersonal communication l and non-aggressive assertiveness required Demonstrates successful conflict management skills and achieving “win-win” solutions required Working knowledge of Microsoft Suite Products e.g. Excel, Power-Point, Word required Knowledge of Medicaid and Medicare regulations required Working Knowledge of UAS-NY preferred Pay Range per Visit: If you are applying to the per diem per visit version of this job, the hiring range is as follows: $80 per visit. 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. 
$151,530.94 - $182,030.94 / year
NYU Grossman School of Medicine is one of the nation's top-ranked medical schools. For 175 years, NYU Grossman School of Medicine has trained thousands of physicians and scientists who have helped to shape the course of medical history and enrich the lives of countless people. An integral part of NYU Langone Health , the Grossman School of Medicine at its core is committed to improving the human condition through medical education, scientific research, and direct patient care. 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. For more information, go to med.nyu.edu , and interact with us on LinkedIn , Glassdoor , Indeed , Facebook , X and Instagram . Position Summary: We have an exciting opportunity to join our team as a Family Nurse Practitioner in Peds & Adult GI in Manhattan. In this role, the successful candidate will be responsible for the provision, coordination, and assurance of comprehensive nursing care using nursing process and pertinent standards of care, the diagnosis of illness and physical conditions, and performance of therapeutic, corrective, and prescriptive measures of the designated inpatient or outpatient patient population within a collaborative practice agreement established with a specific physician on the staff of NYU Hospitals Center Job Responsibilities: Plans and organizes care to meet individual patient needs and to ensure appropriate clinical resource utilization per protocols, pathways, and other means. Monitors and trends the cost effectiveness of the position, particularly as it relates to the efficiency and performance indicators established for the service. Assists in the preparation, implementation, and evaluation of research protocols when applicable. Works collaboratively with nursing and other disciplines in the development and implementation of clinical studies within the area of expertise. Uses evidence-based health care literature to advise and support appropriate practice changes within the designated service. Participates in the development and monitoring of patient outcomes per established practice protocols for purposes of quality and performance improvement. Serves as a clinical expert and resource for the education of peers and other health professionals. Maintains current expertise in area of practice. Promotes own professional growth and development in clinical and managerial role. Considers needs and behaviors of specific patient age and cultural groups in all patient care. Evaluates treatment and health care plans for effectiveness and modifies per clinical standards and practice protocols. Practices as a member of the allied health staff according to the rules and regulations of the Medical Staff and bylaws as outlined in the delineation of privileges. Prescribes medical equipment, devices, physical and occupational therapy, and home health services per practice protocol. Prescribes in-patient and discharge medications according to New York State law, including controlled substances with DEA authorization. Works collaboratively with the attending physician, consulting physician(s), and other disciplines to identify, develop, and implement an appropriate plan of care that maximizes individual patient/family preference and enhances quality, access, and cost-effective outcomes. Formulates the plan of care, along with the attending physician, patient and family, based on expected goals of care and length of stay. Orders customary laboratory, radiological and diagnostic studies per practice protocols, differentiates between normal/abnormal findings and follows protocols for abnormal findings, which may include referral to consulting physicians per customary pattern of the attending MD or with the collaborating physician. Performs complete health history, physical examination and psychosocial assessment of patients within the designated practice or clinical unit. Functions as a respectful member of the health care team. Participates in designated activities related to professional nursing standards and regulations of relevant outside agencies. Demonstrates knowledge of the organizations Service Standards and incorporates them into the performance of responsibilities. Facilitates the continuity of care across the continuum of services, e.g. home care, other facilities, appointments with MDs etc. Provides consultation about the therapeutic regimen to the nursing staff responsible for the patients care in the hospital setting. Works collaboratively with nursing leadership to ensure timely communications with the nursing staff. Works collaboratively with the attending physician to maintain timely and appropriate communication with family members, housestaff, other disciplines and ancillary services. Participates in the development and revision of interdisciplinary and nursing standards, patient and family education materials as relevant to area of practice and expertise. Works collaboratively with the interdisciplinary team including the attending physician to develop and implement the therapeutic plan of care for a group of patients and ensure communication with family members. Minimum Qualifications: To qualify you must have: Licensure: Current registration as Professional Nurse in New York and Registration as Nurse Practitioner in New York. Education: Master's Degree in Nursing. Certification required (as soon as feasible following graduation from NP graduate program) by ANCC or Board Certification from other specialty organization that certifies Nurse Practitioners in a clinical area of practice. Basic Life Support Certification through the American Heart Association.. Required Licenses: Registered Nurse License-NYS, Nurse Practitioner-NYS, Basic Life Support Cert Preferred Qualifications: Advanced Life Support certification (ACLS, PALS) through the American Heart Association or Neonatal Resuscitation certification (NRP) through the American Academy of Pediatrics may be required based on your selected privileges. At least five years of clinical nursing practice in the care of the patient population served; ability to apply nursing process toward achievement of specific outcomes in an organized fashion, which addresses patient/family safety and satisfaction. Previous experience as a nurse practitioner is preferred. Evidence of excellent interpersonal skills, effective communication skills, creative problem solving and excellent critical thinking and leadership; previously demonstrated ability to facilitate group processes and work cohesively and collaboratively as member of the interdisciplinary team; Effective change agent. Physical stamina, manual dexterity, visual and aural acuity to perform responsibilities. Membership in professional specialty organizations desirable Qualified candidates must be able to effectively communicate with all levels of the organization. NYU Grossman School of Medicine 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 Grossman School of Medicine 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 $151,530.94 - $182,030.94 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 
