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Overview Behavioral Health Counselors provide supportive counseling, advocacy, and education to help patients and their families navigate mental illness, access community resources, and manage symptoms to help them remain safely in the community This is an experienced, master’s level social services role that provides direct care as part of a team. Join us in building on our 130-year history and become a part of the Future of Care that is strengthening communities with high quality, integrated behavioral health programs. VNS Health Behavioral Health team members provide vital client-centered behavioral health care to New Yorkers most in need, across all stages of life and mental well-being. We deliver care wherever our clients are, including outpatient clinics, clients’ homes, and the community. Our short- and long-term service models include acute, transitional, and intensive care management programs that impact the most vulnerable populations, from children, to adolescents, to aging adults. As part of our fast-growing Behavioral Health team, you’ll have an opportunity to develop and advance your skills, whether you’re early in your career or an experienced professional. What We Provide • Attractive sign-on bonus and 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, CEU credits, and advancement opportunities, • Interdisciplinary network of colleagues through the VNS Health Social Services Community of Professionals What You Will Do • Performs social work assessments of patients/families; opens cases as appropriate, • Develops treatment plan and goals for patients/families as appropriate, • Provides supportive counseling and/or supportive therapy as well as ongoing social work services, • Collaborates and refers to appropriate agencies as required, • Aids in obtaining community services to patients, families and other caregivers, • Provides psycho education and advocacy for patients and families, • Assists staff, patients, families, and other caregivers to understand third party reimbursement, entitlements and community resources, • Initiates and maintains written and verbal communications according to VNS Home Care policy, • Performs established workflow procedures, • Maintains productivity sufficient to meet VNS Home Care goals, • Acts as liaison with other community agencies, • Participates in related VNS Home Care activities, e.g., utilization review, staff meetings, education programs, etc. Licenses and Certifications: Valid NYS ID or NYS driver’s license may be required as determined by operational needs. Education: Master's Degree in Social Work, Counseling, or related degree required Work Experience: Minimum one year of social work experience in a mental health or social service setting required Pay Range USD $31.94 - USD $38.20 /Hr. About Us VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.

Job DescriptionRegistered Nurse – Nursing Home Surveyor / Complaint Investigator – New Rochelle, NY (#25141) Location: New Rochelle, NY Employment Type: Contract / Travel Hourly Rate: $45/hour About Greenlife Healthcare Staffing Greenlife Healthcare Staffing is a leading national recruitment agency committed to connecting skilled healthcare professionals with premier job opportunities. We partner with hospitals, nursing homes, clinics, and private practices to place candidates in roles that align with their career goals. Position Overview We are currently seeking an experienced Registered Nurse – Nursing Home Surveyor / Complaint Investigator for a Review Company based in New Rochelle, NY. In this dynamic contract/travel role, you will conduct regulatory compliance surveys, investigate complaints (including abuse/neglect), and help ensure safe, quality care in long-term care settings. Key Responsibilities • Conduct surveys, complaint investigations (including abuse/neglect), and surveillance in long-term care facilities, • Draft Statements of Deficiencies (SODs) using Principles of Documentation, • Evaluate compliance with Plans of Correction within required timelines, • Input findings into federal and state databases, • Participate in state monitoring during Immediate Jeopardy cases, • Attend staff meetings and provide testimony in administrative hearings as needed, • Comply with DOH schedules, policies, and procedures, • Travel to assigned facilities based on your work schedule Greenlife Healthcare Staffing Empowering Healthcare Professionals. Enriching Lives. Requirements Qualifications Education & Licensure: • Bachelor's degree in Nursing (preferred), • 2+ years of experience in utilization review, claims adjudication, medical review, fraud investigation, surveillance, or monitoring activities, • 3+ years of clinical or administrative nursing experience, • BSN + 2 years of clinical or administrative experience, • SMQT Certification preferred (must obtain within 12 months)

Job DescriptionOverview Essen Health Care is a growing community healthcare network that provides high quality, compassionate, and accessible medical care to some of the most vulnerable and under-served residents of New York State. Guided by a ‘population health’ model of care, Essen has five integrated clinical divisions offering services in primary & specialty offices, urgent care centers, and nursing homes, as well as house calls for home bound patients; all clinical services are also offered via telehealth. Our Care Management division supports patient-centered care through care coordination, complex care management and helping address health-related social needs. Founded in 1999, Essen provides care in all five boroughs of New York City, with a primary focus in the Bronx. Staffed by over 300 primary and specialty care physicians and advanced clinicians, Essen Health Care is one of the largest, most comprehensive private medical groups in New York City. Essen maintains a Clinical Information Services team that maintains our enterprise-wide electronic medical record system, data repository, clinical analytics and population health capabilities. Our Community Services teams creates and sustains relationship with community organizations and agencies and health plans. Essen is dedicated to ensuring the quality of care for all patients and has been designated ‘Level 3 Patient Centered Medical Home’ by the National Committee for Quality Assurance. Essen has won awards for its patient care innovations and recently launched Intention Health Ventures to develop and commercialize our technological innovations. Requirements Job Summary The Director of Population Health will provide strategic direction, leadership, and oversight of all population health initiatives within a large Integrated Delivery System (IDS). The incumbent will be responsible for the planning, development, and implementation of comprehensive population health, value-based care, and performance improvement programs. This includes oversight of HEDIS measures, care management, risk stratification, and utilization management to enhance care quality, promote cost savings, and improve patient outcomes. Responsibilities 1. Population Health Strategy & Program Development Develop and implement a system-wide strategy for population health management aligned with the organization’s mission, vision, and values. Lead the design and execution of innovative care delivery and value-based initiatives to support improved health outcomes and cost efficiency. Collaborate with senior leadership to set short- and long-term goals and performance metrics for population health, ensuring alignment with organizational strategy. 2. HEDIS Oversight and Quality Reporting Oversee the development, implementation, and monitoring of HEDIS-related processes to ensure the highest level of quality and compliance with regulatory requirements. Ensure accurate and timely data collection, reporting, and analysis for HEDIS, CMS Stars, and other quality measures. Identify performance gaps and drive improvement initiatives to enhance HEDIS performance across the organization. 3. Care Management and Coordination Provide leadership and direction for care management teams, including nurses, social workers, and care coordinators, to ensure effective care coordination for high-risk, high-cost patient populations. Implement risk stratification models and evidence-based care pathways to optimize patient outcomes and resource utilization. Ensure coordinated transitions of care, reduce readmissions, and improve patient engagement through strong interdepartmental collaboration. 4. Utilization Management Oversee utilization management activities, ensuring adherence to clinical guidelines and best practices to optimize care delivery and reduce unnecessary costs. Collaborate with providers, payers, and care teams to design and implement strategies to reduce avoidable hospital admissions, readmissions, and Emergency Department (ED) visits. Drive the utilization review process, establishing benchmarks and key performance indicators to monitor performance and identify improvement opportunities. 5. Data Analytics and Technology Integration Work closely with IT and Data Analytics teams to leverage population health management software and analytic tools for monitoring, trending, and forecasting clinical and financial outcomes. Utilize data-driven insights to identify population health trends, develop targeted interventions, and measure program effectiveness. Champion the use of electronic health records (EHR) to streamline care coordination, clinical documentation, and performance reporting. 6. Collaboration and Stakeholder Engagement Develop strong partnerships with physicians, clinical leaders, external healthcare organizations, community-based organizations, and payers to foster a culture of collaboration for population health initiatives. Serve as a subject matter expert for population health and value-based care, providing education, training, and guidance to internal stakeholders. Represent the organization in community forums, professional associations, and conferences to promote best practices in population health. 7. Regulatory Compliance and Accreditation Maintain current knowledge of federal, state, and local regulations and accreditation standards related to population health, quality, and value-based care. Ensure the organization’s compliance with regulatory requirements and accreditation standards (e.g., NCQA, CMS) related to population health and quality programs. Lead audits, accreditation processes, and quality improvement initiatives to meet and exceed compliance obligations. 8. Financial and Operational Management Develop and manage the budget for population health initiatives, ensuring cost-effectiveness and alignment with strategic priorities. Monitor financial performance and ROI for population health programs, implementing course corrections as needed. Identify and secure grants, partnerships, and other funding opportunities to support and expand population health efforts. 9. Leadership and Team Development Recruit, mentor, and retain high-performing population health and care management teams, fostering a culture of innovation and continuous learning. Provide leadership, coaching, and professional development opportunities to direct reports and cross-functional team members. Establish performance expectations and conduct regular performance evaluations, ensuring accountability and alignment with organizational goals. Qualifications 1. Education and Certification Master's degree in public health, Health Administration, Nursing, Business Administration, or a related field required. Clinical background (RN, MD/DO, or similar) preferred but not required. Certification in Population Health Management, Case Management, or Healthcare Quality (e.g., CPHQ, CCM) is highly desirable. 2.Experience: Minimum of 7–10 years of progressive leadership experience in population health, care management, or quality improvement within a large integrated delivery system or health plan. Demonstrated success in implementing and overseeing HEDIS, CMS Star Ratings, or other quality improvement programs. Proven track record of leveraging data analytics to drive strategic decisions, reduce costs, and improve clinical outcomes. Experience in leading interdisciplinary teams and managing complex, system-wide initiatives. 3. Knowledge and Skills: In-depth knowledge of population health principles, healthcare delivery models, and value-based care arrangements (e.g., ACOs, bundled payments, capitation). Familiarity with healthcare regulations, accrediting body standards (e.g., NCQA), and best practices in quality management and performance improvement. Exceptional analytical and problem-solving skills, with the ability to interpret complex data and implement evidence-based strategies. Strong leadership, communication, and interpersonal skills to inspire teamwork, influence stakeholders, and drive organizational change. Proficiency in Microsoft Office Suite, EHR systems, and population health management software. Benefits Equal Opportunity EmployerEssen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population

Travel Nurse RN - Case Manager, Utilization Review - $3,029 per week at Medical Solutions summary:.The Travel Nurse RN - Case Manager, Utilization Review role involves providing high-quality nursing care while managing cases for patients during a 13-week travel assignment.This position offers flexib

Job Description Job Title – Planner - Level 1 (1-5 years) Location - White Plains, New York 10601, Hybrid Duration – 12+ Months Job Functions & Responsibilities • Plan departmental work tasks utilizing established methods, policies, and procedures to optimize resource utilization within budgetary constraints to deliver high quality, on time services., • Prepare overall project plans including schedules, critical path, and milestones compliance metrics to ensure schedule and budget adherence., • Partner with the building’s Chief Operating Engineer to create and update maintenance job plans for existing/new equipment., • Utilize the Maximo system for documenting and tracking the performance of equipment, spare parts, and compliance with ISO 55000., • Coordinate and track the disposal of end-of-life assets., • Support compliance with Environmental Health and Safety and Code Compliance policies and procedures including tracking of required documentation (permits, HASPs, JSAs)., • Perform interior and exterior building survey inspections with focus on safety. Prepare a detailed report of findings, develop a corrective action plan, and follow up to ensure closeout., • Prepare preliminary space and furniture conceptual layouts for review and approval prior to detailed design development. Support the Property Administrator in updating building seating charts., • Assist project closes outs by obtaining “as built” drawings, equipment training and O&M manuals. Coordinate with Design & Drafting Department regarding Configuration Management policy requirements for updated drawings, documentation, and archiving., • Provide backup coverage and support to other Facility Management staff as needed and assist with various projects and day to day activities as directed. Skills • Proficiency with software, including but not limited to: Maximo, Microsoft Office Suite, MS Project, and a design software package such AutoCAD, Revit, Sketchup or Visio., • Experience with Work Management Systems and Scheduling., • Effective communication skills both oral and written., • Ability to handle multiple projects from start to finish., • Knowledge of OSHA, construction standard practices and sequence., • Ability to read and annotate architectural drawings. Education & Certifications • 2-year AAS Engineering degree., • 3-5 years related construction management or planning experience with A/E’s and contractors., • Space planning experience preferred., • Safety compliance experience preferred., • Valid driver’s license., • Regulatory/Certification-Required Competencies, • OSHA 30 (training available upon hire)

Job Description Reports To: Senior Vice President, Clinical Operations Program: Clinical Operations Location: White Plains, NY Hours Per Week: 35 hours (Full time, 5 days on site per week) FLSA Status: Full Time, Exempt Annual Salary Range: $90,000 to $95,000 Summary Description The Clinical Director is responsible for overseeing the daily administration and clinical operations of our Comprehensive Health Center, licensed by the Office of Addiction Services and Supports (OASAS) as an Article 32 substance use treatment program. The Director provides oversight and supervision to all staff and provides direct services to clients as needed. The Director will support recovery by providing services that reflect our deeply held values, including the recognition of individual rights of self-determination, choice, shared decision-making, and collaboration. The Director is a member of an interdisciplinary professional clinical team that utilizes an evidence-based integrated treatment approach along with harm reduction strategies that are strength-based, trauma-informed, and person-centered. Key Responsibilities: • Maintain responsibility for the daily clinical and administrative operations of the program, including staff supervision, compliance with OASAS regulatory guidance and statistical reporting standards, budget development, generation of services as per APG methodology, crisis management, and program monitoring/development., • Review and approve initial needs assessment and treatment plans., • Implement and monitor policies and procedures in accordance with agency guidelines., • Participate in program evaluation activities and the utilization of evidence-based practices., • Establish and foster community and provider relationships., • Market clinic services to new potential referral sources, including elements of community outreach and opportunities to implement new and/or expanded programs., • Collaborate in the development of semi/annual evaluation of program services and incorporate findings into future planning practices., • Participate in the utilization review and quality improvement (QI) related activities as assigned by Senior Management., • Collaborate in the development and execution of Key Performance Indicators (KPIs), and the analysis of data for continued program development within the clinic., • Support telehealth services in the clinic., • Knowledge of OASAS Reporting Systems (CDS, LOCADTR) and PSYCKES, preferred., • Bilingual Spanish Speaking, preferred., • Must be reliable and able to work independently and understand the importance of maintaining confidentiality., • Demonstrates understanding of 42CFR, HIPAA Privacy Standards, and related agency policies., • Have and maintain a valid Driver's License with a driving record that is satisfactory to our insurance carrier, and have and maintain a Defensive Driving certification., • Must be cleared and maintain clearance through the NYS Justice Center through fingerprinting for a Criminal History Records search., • Must be cleared and maintain clearance by the DOS New York State Sex Offender Registry., • Pre-employment drug screen is required as a condition of employment., • Must be cleared and maintain clearance by the Justice Center for the Protection of People with Special Needs Staff Exclusion List (SEL) and the New York State Medicaid Exclusion List., • Must be cleared and maintain clearance by the NYS Office of Children and Family Services (OCFS) for instances of child abuse and/or neglect., • Must be legally eligible to work in the United States. Key Performance Indicators (KPI’s): • Maintain anchor and licensing standards as indicated by the OASAS regulations., • Meet the clinic’s service provision targets as projected in the budget., • Stay current with the OASAS standards of care and make any programmatic changes to include updating policies and procedures to meet quality expectations., • Provide the necessary trainings as indicated by the clinic’s regulations and keep the tracking data., • Maintain the OASAS data base portal updated with all indicated reporting as per the regulations., • Increase census capacity as indicated in the clinic targets projections. Requirements: • Must have experience as a qualified health professional (QHP) as defined by Part 822 of the OASAS regulations; i.e. LMSW, LCSW, or Licensed Psychologist, • A Master's degree is required with five years of prior clinical work experience in the substance use disorder field, at least three years of which must be in a supervisory capacity., • Willingness to obtain CASAC or CASAC-T within 12 months post-hire., • Strong computer knowledge: typing, communication tools, scheduling tools and web browsers., • Proficiency in Microsoft Office suite and database management systems., • Fluency in English (Reading, Writing, Speaking)., • Must be cleared and maintain clearance by applicable regulatory clearances as required., • Legally eligible to work in the United States without sponsorship. Special Considerations: • Work schedule:, • 100% onsite, 5 days per week., • Hours per week, reporting structure, and location are subject to change per organizational needs. Mandated Reporter: This is a Mandated Reporter position. The NYS Justice Center legislation defines anyone who has regular and substantial contact with any person with special needs as a “custodian” under the law and, therefore, a mandated reporter. You can be held liable by both the civil and criminal legal systems for intentionally failing to make a report. Greater Mental Health of New York is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information. Greater Mental Health of New York is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request a reasonable accommodation, contact the Human Resources Department.

Job Description Director, Care Management Registered Nurse or Licensed Social Workers are considered for this position Are you a strategic and experienced leader in care management? We are seeking a Director, Care Management to join our team! This full-time, day position (Monday - Friday, 9 AM - 5 PM) offers a $10,000 sign-on bonus and a competitive salary range of $130,000 - $190,000+ In this pivotal role, you'll be the central resource for our Executive Team, driving efficient, patient-centered strategies that ensure appropriate financial reimbursement. You'll have 24-hour accountability for planning and directing departments across Access, Utilization Review, Denials and Appeals, Care Coordination, Discharge Planning, Clinical Social Work, Recovery and Disease Management, and Contracting. You'll also collaborate across disciplines, with payers, and community agencies to optimize clinical outcomes within ethical, legal, and regulatory parameters. What You'll Do: • Lead Operations: Oversee daily operations of the Care Management Department, including hiring, education, discipline, and budget management., • Strategic Planning: Develop department goals aligned with the hospital's mission, manage personnel, and prepare and monitor departmental budgets., • Quality Assurance: Ensure the delivery of high-quality department and clinical services, adhering to hospital and regulatory standards., • Team Collaboration: Work closely with interdisciplinary teams, promoting a collaborative environment within your division and across the hospital., • Performance Improvement: Drive key departmental goals, including reducing length of stay, readmissions, and denials, while improving discharge satisfaction and transitional planning., • Regulatory Compliance: Ensure all departmental policies are compliant with regulatory requirements., • Mentorship: Guide and counsel Nurse Care Managers and Social Work Managers in their professional development and unit planning., • Committee Participation: Actively participate in various hospital committees, including overseeing the Utilization Review Committee Meeting. What You'll Bring: • Education:, • For RNs: BSN or MSN required, or a BSN with a Master’s degree in clinical or healthcare administration. CMAC (Certified as a Case Management Administrator) or CCM (Certified Case Manager) certification preferred., • For Social Workers: Master’s degree in social work, with a Licensed Social Worker (LMSW or LCSW) credential. CMAC or CCM certification preferred., • Experience:, • At least one year of acute hospital experience., • One year of experience in non-hospital-based healthcare (e.g., home care, insurance, outpatient)., • Previous experience managing staff or successful project implementation., • Knowledge:, • Strong computer skills, critical thinking abilities, understanding of DRGs, Medicare Regulations, Medical Necessity Criteria, Patient Bill of Rights, and HIPAA. If you're a results-oriented leader passionate about optimizing patient care and driving operational excellence, we encourage you to apply!

Job Description New Rochelle Region - Become SMQT Certified! $3,000 Sign-on Bonus Based in New Rochelle, the Nursing Home Surveyor/ Complaint Investigator will assist the New York State Department of Health (NYSDOH), Office of Aging and Long-Term Care, with surveillance and investigation activities related to nursing homes (long term care). These activities are mandated to evaluate facility performance and monitor the quality of care and services provided. In this role you will participate as a member of an interdisciplinary survey/investigation team to review allegations of abuse and neglect, perform surveillance activities/tasks at nursing homes (long term care)/Transitional Care Units (TCUs), and Adult Day Health Care Programs (ADHCP) to determine compliance with the requirements of participation; prepare written reports of investigative findings and prepare Statement of Deficiencies (SOD) within required time frame, using Principles of Documentation. participate in emergency surveys at Skilled Nursing Facilities (SNF’s); participate in State monitoring during Immediate Jeopardy situations; as well as other duties. This position is majority travel, will be onsite at facilities in Sullivan, Orange, Dutchess, Putnam, Rockland, Ulster and Westchester counties. Mileage and accommodation reimbursement provided. Non-travel days are based out of the NYSDOH New Rochelle office -OR- telecommuting, if approved. QUALIFICATIONS: • Demonstrate strong interpersonal skills with the ability to facilitate positive customer satisfaction in situations that are adverse or in controversy., • Ability to successfully work independently with minimal supervision, as well as in a team environment., • Excellent written and verbal skills with the ability to communicate professionally with co-workers, supervisors, providers, medical and administrative personnel, and residents/patients., • Ability to translate collected information into a clear, concise, legal, and defensible document., • Excellent investigative and analytical skills., • Strong computer skills with working knowledge of Microsoft office products, and the ability to learn new programs., • Ability to obtain Surveyor Minimum Qualifications Test (SMQT) certification within 12 months of employment, required., • If approved to work remotely, must have secure internet that meets the speed required to perform all work duties, must have workspace that provides privacy for all work-related calls, and must be able to secure all work-related items when not in use., • NYS Licensed and registered, Licensed Practical Nurse, graduate from an approved practical nursing program, required., • A minimum of two (2) years of experience in performing utilization review, claims adjudication, medical review, fraud investigation, surveillance, or monitoring activities, OR minimum of (2) years of clinical experience in a licensed health care facility, required. The salary range and/or hourly rate listed does not include other forms of compensation or benefits. IPRO is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or military status.

Preferred Qualifications • Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) non-clinical review/auditing experience. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer

Compass Healthcare Consulting & Placement is conducting a search for an experienced RN Administrator for Admissions, Intake & Outreach for a Hospital located in the Bronx, NY. New York State Registered Nurse and Masters Degree in Nursing is required. Opportunity for Clinical RN Administrative Leader for Facility Administrator role. Qualified candidates will have 10-15 years of Management experience, 5+ years experience as a Department Head and 3+ years as an RN Administrator or VP level within a Hospital setting. RN Administrator for Admissions, Intake & Outreach is responsible for overseeing the functions and activities associated with Community Outreach Services, Admitting, and Intake. Reports directly to the Vice President for Admitting, Intake and Outreach Services and maintains an open dialogue with the senior leadership of the hospital and referring partners. Responsibilities: • Continuously monitors and assesses the delivery of services provided by the Community Outreach, Admitting and Intake implementing changes when appropriate., • Acts as liaison between Hospital and referring institutions and providers., • Actively engages in the ongoing marketing of programs and services provided by the Hospital., • Works cooperatively with other departments, provider referrers and managed care organizations to facilitate the admission of patients to the various programs provided by the Hospital., • Interfaces with managed care organizations to facilitate reimbursement for services provided by the Hospital. Oversees the appeals process for those cases for which reimbursement has been denied., • Conducts interdepartmental meetings related to the quality and utilization of clinical services., • Serves on various Hospital committees as assigned., • Attends meetings and seminars as appropriate., • Ensures all related manuals are kept current., • Works within legal, ethical practice standards to his/her position as well as the Hospital's Code of Conduct. Complies with appropriate policies and procedures and brings potential compliance matters to the supervisor or compliance officer., • Oversees and participates in the budget process for his/her assigned departments., • Completes Introductory and Annual Performance Appraisals for all direct reports. Reviews Introductory and Annual Performance Appraisals for other assigned staff., • Oversees the interface with the Finance Office regarding pertinent insurance information, e.g. Medicare, Medicaid and Commercial Insurance., • Elicits recommendations regarding continuous improvement of patient safety from staff., • Encourages reporting of occurrences without fear of reprisal., • Participates in the development of recommendations for improvement in patient safety based on staff recommendations., • Participates in the implementation and monitoring of patient safety programs., • Maintains current knowledge of regulatory requirements which may impact on the delivery of patient services., • Integrates the services of the departments supervised into the day-to-day activities of the Hospital in support of its philosophy and mission., • Develops appropriate goals and objectives for departments supervised. QUALIFICATIONS: • Master of Nursing Degree required., • NYS unencumbered Registered Nurse License required., • Ten (10) to fifteen (15) years of management experience, five (5) of which must be at the department head level. Three (3) years’ experience as an Administrator or Vice President preferred., • Excellent interpersonal skills., • Ability to interface with all levels of personnel., • Excellent written and verbal communication skills., • Ability to analyze detailed statistical and other pertinent data., • Knowledge of and experience in Quality Assessment and Improvement, Utilization Review., • Ability to develop management systems to track data over time. Competitive Salary $190,000.00 - $210,000.00 and excellent Benefits Package! 401(k), Dental insurance, Employee assistance program, Employee discount, Free parking, Gym membership, Health insurance, Health savings account, Life insurance, Paid sick time, Paid time off, Retirement plan, Tuition reimbursement, Vision insurance Qualified Candidates Please Apply Now for Immediate Consideration!

Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. LPN / LVN licensure required Preferred Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and kn

Medical Solutions Direct Hire is seeking a Registered Nurse (RN) Case Manager, Utilization Review for a nursing job in White Plains, New York. What do we do? Medical Solutions is one of the nation's largest providers of total workforce solutions in the healthcare industry, connecting nurses and alli

Medical Solutions Direct Hire is seeking a Registered Nurse (RN) Case Manager, Utilization Review for a nursing job in Hartsdale, New York.Job Description & Requirements.Medical Solutions Direct Hire Job ID #942882.About Medical Solutions Direct Hire.At Medical Solutions, we’re people who care, he

Provides lead level clinical support to healthcare services team supporting one or more of the following functions: care management, utilization management, care transitions, long-term services and supports (LTSS), behavioral health, and other clinical programs, and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Provides level support to healthcare services department staff - devising/implementing delegation assignment strategies, facilitating healthcare services processes and communicating/coordinating activities. • Resolves issues and complaints that arise in day-to-day healthcare services operations and communicates escalation issues to healthcare services leadership. • Assists in training of healthcare services staff according to department standards, policies and procedures. • Maintains a minimal caseload to ensure adherence to appropriate guidelines and provide assistance to staff who have an ongoing member caseloads that may required additional support. • Collaborates with and keeps healthcare service leadership apprised of operational issues, staffing issues, system and program needs. • As a subject matter expert clinical lead, provides support, recommendations and education as appropriate to all other clinical and non-clinical staff. • Monitors healthcare services staff workload for adherence to policies, procedures, guidelines, and program specific requirements. • Actively participates in the department auditing program to review, communicate findings and identify opportunities for improved quality and compliance. • Shares quality and productivity scores with individual staff for awareness. • Provides feedback to healthcare services leadership on staff performance issues and consults with leadership on corrective action as necessary for performance improvement. • May collaborate with leadership to ensure the daily authorization reconciliation report (DARR) is run each work day and cases found non-compliant or missing compliance elements are remediated promptly. • May collaborate with leadership ensuring the care management monitoring tool (CMMT) is run every work day and cases are addressed to maintain health rid assessment (HRA) and care plan compliance. • Acts as liaison to both internal and external customers on behalf of both Molina and healthcare services department areas. • Local travel may be required (based upon state/contractual requirements). At least 4 years experience in health care, and at least 2 years of managed care experienced in utilization management • Registered Nurse (RN) ONLY if required by state contract, regulation or state board licensing mandates. Demonstrated knowledge of community resources. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and demonstrate self-motivation. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Microsoft Office suite/applicable software program(s) proficiency. Registered Nurse (RN). Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. • Prior experience overseeing Utilization Management processes, interQual, MCG guidelines, PEGA experience etc. Work schedule: full time daytime business hours, with some weekends and holiday support may be required. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $29.64 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Required Certifications- BLS, PRI (Patient Review Instrument) Certification, SCREEN Training Certification Unit Type- Case Management (Utilization Review) Trauma Level- 2 Charting System- Allscripts Case load: Floors typically have 33-40 patients; Most floors are split with 1 CM & 1 SW; Caseload: 17

Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. Preferred License, Certification, Association. Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare

JOB DESCRIPTION Job Summary Provides lead level clinical support to healthcare services team supporting one or more of the following functions: care management, utilization management, care transitions, long-term services and supports (LTSS), behavioral health, and other clinical programs, and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Provides level support to healthcare services department staff - devising/implementing delegation assignment strategies, facilitating healthcare services processes and communicating/coordinating activities. • Resolves issues and complaints that arise in day-to-day healthcare services operations and communicates escalation issues to healthcare services leadership. • Assists in training of healthcare services staff according to department standards, policies and procedures. • Maintains a minimal caseload to ensure adherence to appropriate guidelines and provide assistance to staff who have an ongoing member caseloads that may required additional support. • Collaborates with and keeps healthcare service leadership apprised of operational issues, staffing issues, system and program needs. • As a subject matter expert clinical lead, provides support, recommendations and education as appropriate to all other clinical and non-clinical staff. • Monitors healthcare services staff workload for adherence to policies, procedures, guidelines, and program specific requirements. • Actively participates in the department auditing program to review, communicate findings and identify opportunities for improved quality and compliance. • Shares quality and productivity scores with individual staff for awareness. • Provides feedback to healthcare services leadership on staff performance issues and consults with leadership on corrective action as necessary for performance improvement. • May collaborate with leadership to ensure the daily authorization reconciliation report (DARR) is run each work day and cases found non-compliant or missing compliance elements are remediated promptly. • May collaborate with leadership ensuring the care management monitoring tool (CMMT) is run every work day and cases are addressed to maintain health rid assessment (HRA) and care plan compliance. • Acts as liaison to both internal and external customers on behalf of both Molina and healthcare services department areas. • Maintains confidentiality, effective workplace relationships and adheres to company code of conduct. • Attends/participates in departmental, company-wide, and external committees, task forces, or work groups as assigned. groups as assigned. • Local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 4 years experience in health care, and at least 2 years of managed care experienced in utilization management • Registered Nurse (RN) ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. • Demonstrated knowledge of community resources. • Proactive and detail-oriented. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and demonstrate self-motivation. • Responsive in all forms of communication. • Ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving, and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. • Medicaid/Medicare population experience. • Clinical experience. Prior experience overseeing Utilization Management processes, interQual, MCG guidelines, PEGA experience etc. Work schedule: full time daytime business hours, with some weekends and holiday support may be required. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $29.05 - $56.64 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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