Nursing Jobs in Summit, 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. $101,493.51 - $126,000 / 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 Clinical Research Nurse I-Oncology. Through the practice of professional nursing the Oncology Clinical Research Nurse (RN) I prioritizes and advocates for the best interest of the patient enrolled on an oncology clinical trial while maintaining the fidelity of the clinical research protocol and compliance with policies, procedures and regulations. The oncology clinical research nurse works independently under the general supervision of the Clinical Trials Office Management and Leadership and the Principle Investigator for the specific protocol in order to competently support the safe, high quality and compliant conduct of oncology clinical research and ensure the protection of the patient. The primary purpose of the subspecialized oncology clinical research nurse role is to facilitate positive outcomes of safety and quality for patients enrolled on adult oncology clinical trials at the NYU Perlmutter Cancer Center by coordinating and managing patients enrolled on clinical trials by employing the nursing process, clinical skills, critical thinking, evidence-based nursing and an understanding the scientific research. The oncology clinical research nurse I is expected to develop and maintain competencies in clinical research nursing in the first year of the position including but not limited to comprehension and compliance with all NYU PCC Clinical Trials Office policies and procedures, NYU OSR and IRB policies and procedures, familiarity and application of Good Clinical Practice (GCP) guidelines and Federal Regulations that govern the conduct of human subjects research. The oncology clinical research nurse I demonstrates nursing skills as required under NY state and federal regulations for RN licensure and the ability to navigate patients successfully through the course of trial participation within assigned DMG from pre-screening through coming off protocol. Job Responsibilities: 1. Collaborates with healthcare colleagues across all units and departments and with physicians and advanced practice providers utilizing the Ambulatory Care Practice Model. 2. Utilizing the nursing process, nursing assessment skills and critical thinking the Oncology CRN I conducts a thorough research screening visit for potential trial participants per the protocol requirements, including but not limited to a Review of Systems (ROS), baseline and ongoing AE assessment and documentation, and collection of concomitant medications and documents the assessments in the EPIC electronic health record per CTO policies and procedures. 3. Collaborates with investigators and study team members to recruit, enroll and retain patients on clinical trials while ensuring patient safety and protocol fidelity. 4. Collaborates with investigators to evaluate patient eligibility for the specific study. 5. Prepares for and oversees the safe conduct of study treatment visits per protocol. 6. Provides patients with a thorough explanation of a trial prior to obtaining Informed Consent and as part of the ongoing Informed Consent process, in collaboration with the treating physician and provides patient education on an ongoing basis throughout the patient’s course on trial. 7. Responsible for good quality source documentation related to research visits, Adverse Events and Concomitant Medications in compliance with CTO policies and standard operating procedures. 8. Supports and documents the Informed Consent process with non-English speaking individuals per institutional and external regulatory bodies policies and procedures. 9. Collaborates with the CRC(s) in establishing the feasibility, or lack thereof, on protocol implementation based on knowledge of institutional capabilities and limitations, therapy and population of interest; identifies potential feasibility barriers and communicates them to management promptly. Participates in the Feasibility meeting discussion, and provides adequate explanation regarding clinically-related obstacles and potentially relevant solutions in collaboration with nursing and program management. 10. Creates, reviews and approves protocol tracking forms prior to study activation ensuring a double-check process of review within each assigned DMG for each unique protocol and protocol amendment. 11. Learns to develop and independently conduct outpatient and inpatient infusion nursing in-services for all approved protocols within the DMG and on ongoing basis as needed. 12. Supports the safe conduct of elective inpatient admissions for applicable clinical trials in collaboration with the study team, treating investigator and/or PI and management. 13. Provides cross-coverage for other DMGs as needed. 14. Responds promptly to queries requiring clinical input or changes to research nurse generated electronic documentation. 15. Provides timely follow-up to all clinical patient inquiries/concerns. Provides referral, follow up, and or medication management on as-needed basis. Triages research related patient communication in a timely manner and under the direction of the treating investigator. Collaborates with other NYU and PCC departments to resolve patient-related inquiries/concerns. 16. Maintains fluency in disease-specific terminology. Broad understanding of disease(s). Fluency in standard of care treatment modalities; keeping up to date with changes to standard of care treatment modalities for specific disease(s) within each DMG. Provides timely updates to all of CTO team members regarding changes in standard of care treatment modalities. 17. Provides clinical education to patients on ongoing basis, including but not limited to the following areas: understanding the disease process, understanding the protocol-specified treatment, understanding potential side effects, providing education regarding side effects management, providing education regarding laboratory abnormalities, interpreting and providing education related to scan results. Educates patients on the ongoing nature of the Informed Consent process. 18. Reviews the Beacon Build Template in collaboration with the Physician Investigator for all trial patients enrolled onto clinical trials within the assigned or covering DMG. Ensures treatment plan is correctly built into Beacon Build Template and communicates promptly with the Investigational Pharmacy team to ensure timely completion. 19. Oversees the clinical coordination of patient schedules ensuring overall adherence to protocol defined criteria. 20. Provides guidance, training and education to Associate CRCs, CRCs, and Sr. CRCs. 21. Ensure Serious Adverse Events and other reportable information is reported as per regulatory requirements and protocol, institutional and regulatory timeframes. Completes documentation related to Serious Adverse Events in required timeframe, for internal and external review. Provides follow up information, when clinically available, to Serious Adverse Event or Medical Event/Reportable New Information submissions. 22. Maintains knowledge of current SOC and protocol-specific side effect management guidelines, including but not limited to: chemotherapy/immunotherapy guidelines and infusion reaction guidelines. 23. Performs medication review, education, and reconciliation. Investigational medication handling: verification of drug, doses taken, diary review, reconciling discrepancies, education/re-education and proper return of unused drug. 24. Demonstrates regular attendance and maintains a record of attends for unit-based and department staff meetings and educational sessions. 25. Achieves and maintains the requirements of the oncology clinical research nurse ladder demonstrating ongoing professional growth. 26. Additional responsibilities as needed including but not limited to: supports the development of SOP’s, policy changes, education sessions, quality improvement projects. 27. Is flexible to support clinical care needs as the assigned DMG and day off are based on CTO, PCC clinical care needs. 28. Performs other duties as assigned. Minimum Qualifications: To qualify you must have a BSN and New York RN Licensure and BLS. Maintenance of Chemotherapy/Immunotherapy certification through ONS required within the first year of the role. Minimum of 1+ years nursing experience in oncology research nursing or oncology nursing with qualifying experience determined at the discretion of the Director, Clinical Operations. Computer literacy including word processing, spreadsheet and database management skills Excellent analytical, interpersonal, writing and verbal communication skills. The ability to manage priorities and deadlines and maintain service level expectations for tasks. Adaptability, independently completes tasks and works within deadlines and collaborate effectively as part of a team. Commitment to team problem-solving approach using a research and patient-focused model. Ability to multi-task and prioritize in a fast-paced work environment. Organizational skills both to function independently and a s a member of a professional team. Ability to work with diverse groups of people. Required Licenses: Registered Nurse License-NYS Preferred Qualifications: OCN certification preferred. CCRP, CCRC and/or CRN-BC certifications preferred. Experience with EPIC electronic health record preferred. 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 $101,493.51 - $126,000.00 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 $90,000 - $100,000 / year
Registered Nurse (RN) Supervisor 
