Nursing Jobs in Montville, 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. 
$87,692 - $131,538 / year
Description A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate certification as an NP through advanced clinical nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and prescribe for a patient’s condition that falls within their specialty area of practice. NOTE: Medical orders, progress notes and treatments plans are not required to be countersigned by a physician. Responsibilities Roles & Responsibilities: Demonstrates the ability to perform clinical/technical/service/administrative tasks Overall clinical responsibility for the quality, outcomes and effectiveness of various occupational medicine programs in accordance with Medical Center and NYS, JCAHO, CDC and OSHA guidelines. Clinical responsibility for medical services including follow-up, tracking and aggregate reporting Evaluating, diagnosing and treating occupational health and medical center employees/patients. Demonstrates knowledge of Division of Occupational Medicine and Workforce Health policies and procedures and implements them in the delivery of medical services. Demonstrates the ability to utilize computers and computer software to input and access patient information and general reports required for patient treatment and compliance status in the clinic and other Division of Occupational Medicine work sites. Maintains effective communication with clinic physicians on diagnosis and treatment of patients, as well as implementation of Division policies and procedures. Takes a regular proactive role in communicating and interacting with other members of the treatment team. Interact well with corporate and school client contacts Assumes responsibility for progress notes on patient encounters. Maintains accurate and well documented charts. Works with nursing staff to ensure optimal patient care and adherence to compliance program policies and procedures. Demonstrates knowledge of action, dosage and side effects of medication allowed by NYS law. Demonstrates competency in performing treatments and procedures, including blood drawing, EKG test administration, vision and audio tests, spirometry and fit testing. Assists in the development and implementation of protocols for efficient and optimal patient care. Provides for the safety of patients, staff and other employees and visitors in the clinical environment. Participates in on-going QI-QA programs. Develops and presents at educational sessions annually to adult patient populations Demonstrates the knowledge and skills necessary to provide care, based on physical, psychosocial, educational, safety, and related criteria, appropriate to the age of the patients served in assigned area. Participates in the department’s performance improvement activities. Leads annual flu vaccine campaign, organizing and staffing PODs Observes the Health Care System’s compliance policies. Is familiar with and adheres to Medical Center and Department compliance policies and procedures. Proactively demonstrates responsibility and accountability for the timely and complete management, report, and tracking of clinical results. Promptly advises supervising physician of any issues arising in the treatment of patients and/or gathering, recording and dispersal of required medical documentation. Maintains patient/employee confidentiality in the management of information. Maintains security of confidential patient information and tools necessary to provide operational and clinical services at all Division work sites. Keeps documentation required for patient services and data entry secure, organized, up-to-date, clearly labeled and ready for the next member of the health care team in the established handling process. Utilizes time in an efficient, organized manner, while maintaining sensitivity to the need for patients to have sufficient time to communicate effectively. Proactively participates in expansion and improvement of Division of Occupational Medicine and Workforce Health operations at all assigned sites on a fluctuating schedule. Meets regularly with other members of health care team and other staff members to update policy, procedures, new treatment developments and strategies for efficient administration of services. Follows up on patient needs and requests promptly and appropriately. May be required to perform other duties as assigned or perform other duties when necessary. Tracks employees, volunteers and vendors annual health compliance Follows up on employees out on worker’s compensation Initiates referrals to specialty areas and fosters continuity of care Participates in team meetings and conferences Creates MS Power Point graphs to present aggregate data to leadership in meetings re (compliance, Flu program, work place exposures, other) Scans documents into EMR storage system (OnBase) Registers employees, volunteers, vendors, other in EMR system during each visit Answers incoming calls from Call Center Other non—clinical responsibilities as assigned by Medical or Clinical Director Qualifications Requirements: Master's from an accredited Nurse Practitioner Program Current NYS Nurse Practitioner and Registered Nurse licenses and registration certifications. Current ANCC certification. Willing to accept fluctuating hours as needed. Demonstrates a professional, courteous, and respectful attitude, Excellent technical and patient care skills. Excellent communication skills, written and verbal. Working knowledge of personal computers and some prior hands-on experience Models a customer service focus. Respects patient confidentiality, privacy and dignity. Requires appointment to Medical Center Allied Health Personnel Staff. Employer Description Strength through Unity and Inclusion The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai’s unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual. At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history. About the Mount Sinai Health System: Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally. Equal Opportunity Employer The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization. Compensation The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $87692 - $131538 Annually. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits. 
Job Description We are looking for a compassionate and warm Home Health Aide to provide assistance in daily living and personal care services for our clients. This is a rewarding opportunity to make a difference in the lives of patients and their families. Some responsibilities include: Personal care - Bathing, dressing, grooming etc. - Meal and snack preparations - Home Health aide should accompany patient on errands, shopping and medical appointments - Provide companionship, empathy and basic emotional support - Medication reminders Housework - Cleaning the floors ( mop , sweep , vacuum etc.) - Washing dishes - Cleaning the bathrooms - Change the linen - Laundry Hours Choose your own! Pay $19 -$21 Benefit: Health Insurance Flexible schedule Paid time off Certification HHA required (Certified in NY) Our Agency prides itself in caring for our employees like family ! Call 718-596-2255 ext 205 today to join our team! 
Registered Nurse (RN) Supervisor SIGN ON BONUS!! 
