Nursing Jobs in New Rochelle, NY
$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. 
$155,836.71 - $179,789.85 / year
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 $155836.71 - $179789.85 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. 
$68,000 - $115,000 / year
198298 Job Description Performs an age specific plan of care for a designated group of patients using the nursing process of assessment, diagnosis, outcome identification, planning, implementation and evaluation of patient care. Collaborates with physicians and other health team members in coordinating and implementing procedures and treatments. Uses leadership skills/clinical judgment in coordinating patient care and directing/delegating activities of the patient care unit team. Job Responsibility Assesses the patient’s physiologic health status: Conducts patient interview, explains policies and procedures to patient/significant others, reviews patient’s chart and answers questions correctly and courteously; Performs a comprehensive health assessment across all body systems; Determines mobility, sensory deficits, prostheses use, and skin condition and adjusts plan of care, as appropriate; Assesses level of pain and pain management; Communicates/documents patient’s physiologic health status and plan of care. Assesses patient’s psychosocial health status: Elicits perception of medical/nursing care and the expectation of care; Determines coping mechanism, knowledge level, and ability to comprehend; Identifies cultural/ethnic requirements to reduce anxiety and ensure patient satisfaction; Communicates and documents psychological status and care plan; support group, counseling services, social services. Identifies patient outcome: Develops criteria for measurement of patient outcomes; Identifies actual/potential patient problems; Identifies patient’s need for teaching based on psychosocial and developmental assessment; Develops patient outcome statement (s) and establishes individualized patient goals. Formulates the plan of care and establishes the priorities necessary to achieve expected outcome: Coordinates the cost-effective use of supplies, equipment and medication to achieve expected outcome; Documents the plan of care and collaborates with physicians and other health team members. Implements the plan of care: Maintains constant vigilance over patients’ care to ensure that safety precautions/needs are followed (Side rails up, call lights and bedside stand within reach, exam tables in lowest position etc.); Exercises professional skills related to the plan of care; Reassesses patients as needed and appropriately revises plan of care; Correctly administers prescribed treatments; Correctly uses equipment necessary for patient care; Provides emotional support to patient and significant other; Applies scientific principles in performing procedures; carries them out safely, timely and efficiently; Makes accurate observations of patient’s conditions during treatments/procedures. Reports and records same as appropriate; Keeps accurate documentation of patient’s treatment, activity and condition, as well as patient’s responses to medical and nursing interventions; Uses appropriate methods of documentation according to departmental policy; Acts rapidly and effectively during any emergency situation, managing self, patients and other employees; Provides a calm, quiet, restful atmosphere. Communicates effectively with the patient’s family or caretakers; Participates in planning for discharge from ambulatory procedural or operative site and coordinates referrals, as appropriate; Provides discharge instructions to patient and significant other; Participates in patient education and care planning; coordinates referrals and follow-up resources as appropriate; provides clear instructions to patients and significant others regarding treatments, procedures, self-care, and ongoing health management; ensures understanding through teach-back and other evidence-based methods; evaluates the effectiveness of education and care provided by assessing patient outcomes and comprehension. Evaluates care provided for patient outcome: Demonstrates ability to measure effectiveness of care provided and documents same; Performs variance analysis related to outcome data for performance improvement; Designs, implements, and evaluates systems to improve care in Unit; Keeps accurate documentation of patient’s treatment, activity and condition; Uses appropriate methods of documentation according to departmental policy. Collaborates with other care team members in planning and carrying out treatment regimen; provides direction to other members of the care team: Collaborates with the appropriate Physician or Provider on patient’s plan of care; Accurately interprets and implements treatment regimen as prescribed by the Physician or Provider; Assists the Physician or Provider during treatments and/or diagnostic procedures; Keeps the Patient Care Manager/designee and/or Physician or Provider abreast of changes in patient’s condition and/or treatments, as appropriate; Uses clinical judgment in delegating assignments in providing patient care, and ensures that assignments are completed in a timely fashion. Provides wound care and care for pressure ulcers (Stages I–IV): Performs preventive skin care measures; Applies simple dressings, maintaining principles of aseptic technique; Applies warm & cold compresses, consistent with facility procedure; Performs irrigations, consistent with Facility procedure; Performs other procedures related to skin care, as necessary. Administers medications correctly and safely: Correctly identifies medication (action; dosage; side effects and implications for the patient); Meets standard on medication administration examination; Demonstrates preparation of local solutions; Demonstrates preparation of I.V. drips; Administers and documents medication correctly; Administers IVP medication as per department policy and procedure; Educates patients and significant others related to drug and food interactions. Participates in patient and family education: Provides the patient with an explanation of his/her condition as indicated; Communicates assessment data in an orderly fashion by recording, updating and verbalizing pertinent information to care team members and to appropriate agencies; Recognizes and utilizes health teaching opportunities and resources /materials available for this teaching; Provides for early discharge planning and appropriate referrals for post-procedural or operative care; coordinates appropriate referrals for follow-up care, specialty services, or community resources; Evaluates the effectiveness of teaching by feedback from patient/family and documents same. Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but Considered Related Are Not Essential Functions. Job Qualification Graduate from an accredited School of Nursing. Bachelor’s Degree in Nursing, preferred. Must be enrolled in an accredited BSN program within two (2) years and obtain a BSN Degree within five (5) years of job entry date. Current license to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed. 1+ years of experience in Labor and Delivery/ Antepartum highly preferred. Additional Salary Detail The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity). 
