Associate Director, Care Management, RN

VISITING NURSE SERVICE OF NEW YORK - Manhattan, NY

Full-time
Overview
Manages educational programs, pilots, projects and tools designed to improve clinical utilization/authorization for VNSNY field staff and managed care organizations. Oversees clinical utilization assessments and makes recommendations for improvements/revisions based on inter-professional best practices and evidence-based practices

Responsibilities
Provides overall analysis and summary of enterprise data for clinical utilization management and identifies trends for Provider Services management teams and managed care organizations

Serves as a resource and consultant to the regions regarding clinical utilization management. Assists in the preparation of financial summaries of episodic payer utilization, analyzes trends and best practices, and works with regional management to spread these practices throughout the regions

Collaborates with Program Manager, Assessment Integrity Unit and business operations managers around streamling authorization processes and revision of workflows to promote positive patient outcomes while managing clinical utilization, optimizing appropriate reimbursement and ensuring compliance. Identifies areas for improvement; recommends and implements changes

Collaborates with Clinical Education to identify training needs and activities for staff that focus on accurate and appropriate evidence based practice principles, existing tools and guidelines and guideline software applications

Researches literature with team around emerging evidenced based practice guidelines for service level approvals and authorizations and guidance to clinicians

Collaborates with Quality Management to evaluate the effectiveness of work flows and targeted training for clinical utilization. Makes recommendations for changes/improvements as needed

Performs all duties inherent in a managerial role. Ensures effective staff training, evaluates staff performance, provides input for the development of the department budget, and hires, promotes and terminates staff and recommends salary actions, as appropriate

CA2019

Qualifications
License and current registration to practice as a Registered Professional Nurse in New York State required

Bachelor’s Degree in Nursing required. Master’s Degree in Nursing, Health Care Administration, public administration, finance, or other related field preferred

Minimum six years home care experience, with a minimum of two years in a supervisory position, required. Working knowledge of clinical utilization and authorization management principles required. Proficiency in Microsoft Office applications required. Demonstrated analytical skills required. Experience in developing training and education programs preferred