Nursing Jobs in Piermont, 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 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. $118,726 - $128,120 / year
Duties Description New York Psychiatric Institute had immediate job opportunities for Register Nurses (RN), previous psychiatric experience is not required. Candidates from outside or within State Service can apply. As Registered Nurse 1 Psychiatric, you are a vital member of a multi-disciplinary team focused on providing compassionate care through patient-centered and recovery-focused mental health services to individuals with serious mental illness including: Coordinating and providing nursing care Conducting nursing assessments Preparing, implementing, and modifying nursing care plans Providing health teaching, counseling, and education to individuals and families Implementing infection control protocols and procedures Observing and recording individuals symptoms and care; reporting responses to medications or changes in health Minimum Qualifications Candidates from outside or within State Service can be considered for hire under the Hiring for Emergency Limited Placement – Statewide (NY HELPS) program as a Registered Nurse 1 Psychiatric if they have a license and current registration as a registered professional nurse in New York State. OR Candidates within State Service can be considered for transfer to a competitive class position if they have one year of permanent competitive or 55-b/55-c service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Additional Comments If you would like to join the New York State Psychiatric Institute Nursing Team and contribute to a workforce dedicated to public service, we offer a generous benefits package including: Shift Differential for evening & night shifts Nurse Residency Program Alternate Work Schedules Recruitment is for all three shifts. Additional compensation may apply based on shift assignment. 7% shift differential for evening shift. 10% shift differential for night shift. All OMH employees receive a generous benefits package including: NYS medical, dental, & vision insurance Access to tuition assistance programs Excellent opportunities for advancement & professional growth Paid time off – 13 paid vacation days in the first year, 5 paid personal days, 13 paid holidays, & paid sick leave NYS Retirement programs Background checks will be required. Additional Comments: Posted hiring rate includes the sum of the statutory hiring rate for PS&T Grade 18 ($69,964), an Increase Hiring Rate ($9,612), Geographic Pay Differential ($35,000), and Down State Adjustment ($4,150). The posted job rate is the sum of the statutory job rate ($88,970), Geographic Pay Differential ($35,000) and the Down State Adjustment ($4,150). Notes: If you fail to maintain your license and/or registration once you are appointed, action will be taken to remove you from the position. In order to be eligible for appointment and to maintain employment, you cannot be listed as an excluded individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal or Federally assisted program). If you are appointed and subsequently listed as an excluded individual or entity on any of these lists (or excluded from any other Federal or Federally assisted program), you may be terminated from your employment. If appointed you may be required to become an enrolled Medicare provider; obtain and provide to your employer a National Provider Identifier (NPI) number issued by the National Plan and Provider Enumeration System (NPPES); and otherwise actively participate to the degree necessary to allow for your services to be billed through Medicare and Medicaid. If you are appointed and you lose the ability to bill through Medicare and Medicaid, you may be terminated from your employment. 
Part-Time 11PM-7AM Night Nursing Supervisor -Nursing Home Located in Rye Brook, NY Salary Range: $55/HR-$60/HR based on experience Schedule: every other weekend only Tuesday for one week and Tuesday, Wednesday and Thursday for the other week Qualifications: Must have current New York RN license Nursing Supervisor experience preferred Must have experience in long-term care Strong managerial/supervisory skills Strong written and verbal communication skills Responsibilities: Orient clinical staff to their job responsibilities and provide leadership in clinical problem solving. Nurse will evaluate and schedule in-services/training as needed. Ensure department activities and records are in adherence to AAAHC and various licensing and regulatory requirements. #5448 
-At least 1 year of DIALYSIS nursing experience required -must have NYS nursing license (RN/BSN) -compliance -staffing -oversight of the facility as Nurse Manager 
