Clinical Care Manager, Physical Therapist or Occupational Therapist
Company: VNS Health
Location: Hicksville
Posted on: April 20, 2024
Job Description:
OverviewOversees and directs clinical utilization,
authorization, and care management for field staff and/or managed
care organizations to ensure effective utilization and care
management as defined by inter professional best practices. Ensures
clear and appropriate visit utilization using evidence-based
practices to provide positive clinical outcomes and efficient use
of resources. Identifies and addresses inter-professional
performance issues related to utilization management among staff
and provides individualized performance evaluation assessments to
clinical leadership and staff. Utilizes evidence based practices to
care manage individuals to prevent hospitalization occurrences.
Manages relationships with individuals in order to prevent untoward
outcomes. Manages clinical and financial risk of value based
contracts. Works under general supervision.Compensation:$93,400.00
- $116,800.00 AnnualWhat 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
- Authorizes and oversees visits per episode for the optimal
utilization that results in the best possible clinical outcomes and
efficient use of resources.
- Works directly with the patient, via various forms of
communication, texting, virtual visits, and telephone, to achieve
patient stated goals. - -
- Analyzes utilization to ensure visits are made according to
episode utilization guidelines and clinical outcomes best
practices. - Develops/revises utilization policies and practices
based on analysis of past practices to improve utilization.
- Applies clinical experience and judgment to the utilization
management/care management activities.
- Addresses payor authorizations/reauthorizations within
established time frames which includes, but is not limited to,
reviewing clinical reports of providers for relevant patient data,
communicating patient condition to payor case manager in a manner
that is focused and reflects knowledge/understanding of patient
condition/progress, and negotiating authorizations consistent with
clinical data.
- Ensures appropriate utilization of home health care and other
resources for optimal, cost effective care and services by
reviewing clinical reports, DME/supply requisitions, and visit
threshold reports. - Establishes on-going dialogue with payor case
managers and provider disciplines (e.g., nurses, physical
therapist, occupational therapist, speech therapy, social
worker).
- Handles managed care escalated clinical authorizations and
denials.
- Directs field staff -to take actions that address issues and
improve performance, including changing plans of care and notifies
payor case manager of significant changes in patient condition.
Evaluates performance and reports assessments to clinical
management and works with them to set accountability mechanisms and
long-term correction standards. -
- Develops, updates, and teaches curriculum, exercises and
learning materials for clinicians in conjunction with the Learning
& Development and Quality departments to improve on utilization
management. -
- Educates clinicians to follow best practices in utilization
management/care management activities. - Identifies areas of
concern and works with Education department to revise courses as
needed.
- Develops and assigns training activities in conjunction with
the Learning & Development and Quality departments, based on
individual clinicians' learning needs and capabilities. Provides
direction to staff and Clinical Field Manager, via telephone in
response to any situations arising in the field with regard to
visit and patient care planning.
- Provides coaching, education, performance evaluation
assessments, and counseling and discipline, as needed, to
clinicians regarding job performance. - Maintains complete and
timely documentation of assessment and performance management
activity and clinician progress. - Evaluates clinician's
performance for annual performance review process, at the request
of the Clinical Field Manager.
- Participates in special projects and performs other duties, as
needed.Qualifications
- License and current registration to practice as a Registered
Professional Nurse, Physical Therapist, or Occupational Therapist
in NYS required.
- Relevant degree needed for professional licensure
required.
- Population Care Coordination certification required within one
year of job entry date. - -Care Management, Case Management, OASIS
or other applicable certification preferred.
- Minimum two years' experience as a registered nurse, physical
therapist, or occupational therapist required. - -Utilization
management and/or managed care experience preferred. -Proficiency
in Microsoft Office applications required. - -Demonstrated
analytical skills required. -CA2020
Keywords: VNS Health, West Babylon , Clinical Care Manager, Physical Therapist or Occupational Therapist, Executive , Hicksville, New York
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