Clinical Case Manager-Hybrid
Overview The Clinical Manager provides clinical oversight, supervision, and operational support within the Personal Care department, primarily supporting Queens and Long Island. This role serves as a key clinical resource for authorization review, care coordination, documentation compliance, staff supervision, education, and escalation management across managed care, MLTC, private pay, and skilled cases. The Clinical Manager acts as a liaison between field staff, internal teams, payors, providers, and VNS Health Care Managers to ensure the safe, compliant, and timely delivery of care. The position also participates in a rotating on-call weekend clinical triage schedule every 5-6 weeks. What 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 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: Clinical Oversight & Authorization Support Provide clinical guidance to the Authorization/Denials unit and support resolution of authorization escalations Review Start of Care and ongoing authorizations for completeness, accuracy, and clinical appropriateness Provide daily clinical triage support and participate in rotating on-call weekend coverage every 5-6 weeks RNFS Supervision & Staff Oversight Provide clinical oversight and supervision for 3-6 full-time Registered Nurse Field Supervisors (RNFS) and per diem staff Support RNFS onboarding, orientation, training, and shadowing Provide ongoing clinical guidance related to assessments, documentation, patient care concerns, and regulatory requirements Documentation Review, Compliance & Quality Review clinical documentation in HHAX to ensure alignment across assessments, Plans of Care (POCs), PPOCs, 485s, visit frequencies, and clinical notes Investigate and resolve missing, unclear, or removed 485s and documentation discrepancies Review clinical visits and update visit statuses as needed Monitor master week reports to identify missing POCs and coordinate RNFS visits, interim orders, or POC revisions Complete DOH follow-ups, Risk Log reviews, discharge summary reviews, and audit follow-ups Collaborate with Quality Assurance on audits, chart reviews, and quality improvement initiatives Care Coordination, Member Outreach & De-Escalation Coordinate care with providers, payors, VNS Health Care Managers, and internal teams to ensure continuity of care Review and respond to Care Management and CHW assessment findings requiring clinical follow-up Conduct direct outreach to members and caregivers to address complaints, clinical concerns, and service issues Serve as a clinical escalation point for complex cases or member concerns beyond unit-level resolution Staff & Aide Education Provide ongoing clinical education and real-time guidance to RNFS and field staff Participate in Home Health Aide education, reinforcing care plans, safety standards, documentation expectations, and reporting requirements Complete Monthly Education Reports for RN staff related to PPOC adherence, assessments, and 485 alignment Participate in case conferences, team meetings, and hiring interviews Operational & Administrative Support Maintain timely and professional email and internal communications Support RNFS payroll, PTO, leave tracking, and onboarding processes in HHAX Coordinate training logistics, equipment ordering, and scheduling for new and existing staff Private Pay & Skilled Services Support private pay intake processes, addressing missing documentation, credentialing issues, and SOC discrepancies Ensure private skilled cases have appropriate physician orders, supplies, and coordination prior to service initiation Qualifications License Current NYS Registered Professional Nurse (RN) license required Education Associate's Degree in Nursing required Bachelor's Degree preferred Experience Minimum of three (3) years of professional nursing experience Home care, case management, or supervisory experience preferred Skills Strong clinical judgment and communication skills Ability to supervise and support clinical staff Proficiency in HHAX and Microsoft Office Ability to manage competing priorities and clinical escalations Pay Range USD $93,400.00 - USD $116,800.00 /Yr. 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.
