Posted in Other 30+ days ago.
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Type: Full Time
Location: Manhattan, New York
The Visiting Nurse Service of New York (VNSNY) is the nation's largest not-for-profit home- and community-based health care organization, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Counties. For 125 years, VNSNY has been committed to meeting the health care needs of New Yorkers with compassionate, high-quality home health care. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, members, and clients from before birth to the end of life.
Each day, more than 13,000 VNSNY employees- including nurses, rehabilitation therapists, social workers, other allied professionals, and paraprofessionals- deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 48,000 patients and members, helping them to live the best lives possible in their homes and communities.
Develops, implements and oversees cost-effective, quality focused services that meet or exceed all regulatory and corporate standards for assigned product lines of VNSNY CHOICE Health Plans. Ensures regulatory compliance in all aspects of clinical operations including medical management, utilization management, and UAS assessments for the assigned product lines. Provides leadership in the development and oversight of plan-wide initiatives that form the basis for continuous improvement and customer satisfaction. Works under limited direction.
Education: Bachelor's Degree in Business or a related discipline or the equivalent work experience required.
Experience: Minimum ten years of clinical experience and a minimum of five years of Utilization Management experience in a managed care/HMO organization required. Minimum five years managerial experience required. Experience with State and external accreditation managed care audits and reviews required Experience with writing and implementing program level policy and procedures required. Proficient with computer and software programs (e.g.; Microsoft Word, Excel) and the Internet required. Experience applying medical management treatment guidelines, such as InterQual / McKesson, Milliman, or other practical management guidelines required.