#hiring Clinical Assessment Manager, New York City, United States, $106K, fulltime #jobs #jobseekers #careers $106K #NewYorkCityjobs #NewYorkjobs #HealthcareMedical
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Overview Assesses member needs and identifies solutions that promote high quality and cost effective health care services. Manages requests for services from providers, members, and care management team and renders clinical determinations in accordance with VNS Health Plans policies as well as applicable state and federal regulations. Delivers timely notification detailing VNS Health clinical decisions. Coordinates with VNS Health Plans team, subject matter experts, physicians, member representatives, and discharge planners to ensure care is appropriate, timely and cost effective. Works under general supervision.Compensation: $85,000.00 - $106,300.00 AnnualConducts 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.Utilizes VNS Health Plans and state approved assessment questionnaire, guidelines and documentation as well as interviews with members, family, and care providers in decision-making.Performs in-home assessment for members who have identified significant changes in condition since last in-home assessment; provides comprehensive review and determination of member's needs, including completion of UAS assessment questionnaire, tasking tool, and a projected service plan. Visits include all areas serviced by VNS Healt including upstate and downstate counties.Performs in-home assessment on members to determine the appropriate service plan, including completion of UAS assessment questionnaire, tasking tool, and a projected service plan. Visits include all areas serviced by VNS Health.Examines standards and criteria to ensure medical necessity and appropriateness of service, admissions, and lengths of stay. Performs prior authorization and concurrent reviews to ensure service and covered benefit is medically necessary and being conducted in the right setting. Uses effective standards of review, service determination, resource management, education and related interventions to promote improved quality of care and/or life, ensure cost effective medical outcomes, prevent hospitalizations when possible, prevent complications in members under our care when possible, provide continuity of care, and ensure appropriate levels of care are received Ensures compliance with state and federal regulatory standards and VNS Health policies and procedures. Identifies opportunities for alternative care options and contributes to the development of a safe member centered service plan Issues request determinations, including Notice of Action letters, and other forms of communication to members and pro
