Clinical Case Manager-Hybrid

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  

• 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

• 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

• 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

• 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

• 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

• 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

• 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

License

• Current NYS Registered Professional Nurse (RN) license required

Education

• Associate’s…