Clinical Case Manager-Hybrid

OverviewThe 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 ProvideReferral 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 SupportProvide clinical guidance to the Authorization/Denials unit and support resolution of authorization escalationsReview Start of Care and ongoing authorizations for completeness, accuracy, and clinical appropriatenessProvide daily clinical triage support and participate in rotating on-call weekend coverage every 5–6 weeksRNFS Supervision & Staff OversightProvide clinical oversight and supervision for 3–6 full-time Registered Nurse Field Supervisors (RNFS) and per diem staffSupport RNFS onboarding, orientation, training, and shadowingProvide ongoing clinical guidance related to assessments, documentation, patient care concerns, and regulatory requirementsDocumentation Review, Compliance & QualityReview clinical documentation in HHAX to ensure alignment across assessments, Plans of Care (POCs), PPOCs, 485s, visit frequencies, and clinical notesInvestigate and resolve missing, unclear, or removed 485s and documentation discrepanciesReview clinical visits and update visit statuses as neededMonitor master week reports to identify missing POCs and coordinate RNFS visits, interim orders, or POC revisionsComplete DOH follow-ups, Risk Log reviews, discharge summary reviews, and audit follow-upsCollaborate with Quality Assurance on audits, chart reviews, and quality improvement initiativesCare Coordination, Member Outreach & De-EscalationCoordinate care with providers, payors, VNS Health Care Managers, and internal teams to ensure continuity of careReview and respond to Care Management and CHW assessment findings requiring clinical follow-upConduct direct outreach to members and caregivers to address complaints, clinical concerns, and service issuesServe as a clinical escalation point for complex cases or member concerns beyond unit-level resolutionStaff & Aide EducationProvide ongoing clinical education and real-time guidance to RNFS and field staffParticipate in Home Health Aide education, reinforcing care plans, safety standards, documentation expectations, and reporting requirementsComplete Monthly Education Reports for RN staff related to PPOC adherence, assessments, and 485 alignmentParticipate in case conferences, team meetings, and hiring interviewsOperational & Administrative SupportMaintain timely and professional email and internal communicationsSupport RNFS payroll, PTO, leave tracking, and onboarding processes in HHAXCoordinate training logistics, equipment ordering, and scheduling for new and existing staffPrivate Pay & Skilled ServicesSupport private pay intake processes, addressing missing documentation, credentialing issues, and SOC discrepanciesEnsure private skilled cases have appropriate physician orders, supplies, and coordination prior to service initiation QualificationsLicenseCurrent NYS Registered Professional Nurse (RN) license requiredEducationAssociate’s Degree in Nursing requiredBachelor’s Degree preferredExperienceMinimum of three (3) years of professional nursing experienceHome care, case management, or supervisory experience preferredSkillsStrong clinical judgment and communication skillsAbility to supervise and support clinical staffProficiency in HHAX and Microsoft OfficeAbility to manage competing priorities and clinical escalations Pay RangeUSD $93,400.00 - USD $116,800.00 /Yr. About UsVNS 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.

Created: 2026-02-06