Clinical Case Manager-Hybrid

OverviewThe Clinical Manager provides clinical leadership, oversight, and operational support within the Personal Care department. This role serves as a key clinical resource supporting authorization review, care coordination, documentation compliance, staff supervision, and patient escalation management across managed care, MLTC, private pay, and skilled cases.This leader partners closely with field staff, internal departments, payors, providers, and care managers to ensure safe, compliant, and timely delivery of services. 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 Leadership & Authorization SupportProvide clinical guidance to the Authorization/Denials unit and resolve escalations.Review Start of Care (SOC) and ongoing authorizations for accuracy and appropriateness.Provide daily clinical triage support and participate in rotating weekend on-call coverage.Staff Supervision & DevelopmentSupervise and support 3–6 full-time Registered Nurse Field Supervisors (RNFS) and per diem staff.Lead onboarding, orientation, shadowing, and role-based training.Provide ongoing supervision related to assessments, documentation, patient care, and regulatory compliance.Documentation, Compliance & QualityReview clinical documentation to ensure alignment across assessments, POCs, PPOCs, 485s, and visit notes.Investigate documentation discrepancies and ensure timely resolution.Monitor reports to identify gaps in Plans of Care and coordinate corrective action.Partner with Quality Assurance on audits, chart reviews, and quality improvement initiatives.Care Coordination & Escalation ManagementCoordinate care with providers, payors, care managers, and internal teams.Conduct member and caregiver outreach to resolve complaints, clinical concerns, and service issues.Serve as a clinical escalation point for complex cases.Education & Operational SupportProvide ongoing clinical education to RNFS, field staff, and Home Health Aides.Complete monthly RN education reporting and participate in case conferences and interviews.Support payroll, PTO tracking, onboarding, and training logistics.Oversee private pay and skilled case readiness, ensuring proper orders and coordination prior to service initiation.Work ScheduleHybrid role:2 days required on-site in office3 days remoteSchedule subject to change QualificationsQualificationsCurrent NYS Registered Professional Nurse (RN) license requiredAssociate’s Degree in Nursing required; Bachelor’s Degree preferredMinimum 3 years of professional nursing experienceHome care, case management, or supervisory experience preferredStrong clinical judgment, leadership, and communication skillsProficiency in HHAX and Microsoft OfficeAbility to manage multiple 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: 2026-04-01