Location
Syracuse, NY | United States
Job description
Summary Description: This position is responsible conducting face to face assessment of members in their home and/or facility. This is accomplished by utilizing required NYS UAS Assessment Tools to determine functional status, medical, behavioral, psychological, and community resource needs for coordinating, integrating, and monitoring the use of medical and health care services for members; The SN UAS Nurse may also perform other technical and administrative tasks essential to the efficient operation of the department.
Essential Responsibilities / Accountabilities: - Conducts face to face assessment of members utilizing required NYS UAS Assessment Tools, and/or other tools as directed by NYS or other regulatory bodies, to determine functional status, medical, behavioral, psychological, and community resource needs, as well as members level of work capacity and related restrictions/limitations.
- Collaborates with interdepartmental teams and external stakeholders, if necessary, to assist in the development of Person-Centered Service Plan; Clarifies benefits, policies, and procedures for current members, providers, and community-based agencies.
- Assesses, plans and implements care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care.
- Identifies social service programs; including financial, psychosocial, community and state supportive services available to augment the need for LTSS services.
- Refers appropriate cases to governmental agencies (e.g. APS/CPS) as needed, and any suspected/possible Medicaid fraud to the Special Investigations Unit (SIU) or designated internal/external entity.
- Communicates with all internal and external stakeholders to obtain the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
- May be required to attend Fair Hearings with Medical Director relating to specific cases.
- Attends departmental meetings, as required.
- Works independently, as well as collaboratively, with members and internal/external stakeholders, resulting in improved member health.
- Manages complex assignments.
- Serves as a positive role model to others in the department.
- Adheres to all Corporate and Departmental policies and ensures all regulatory requirements such as DOH, CMS, Medicaid, and accreditation requirements such as NCQA, URAC and HEDIS functionalities are met or exceeded.
- Process Management and Documentation -
- Identifies, recommends and assesses new processes as necessary to improve productivity and gain efficiencies.
- Assists in updated departmental policies, procedures and desk-top manuals relative to their function.
- Serves as subject matter expert and if called upon, works directly with the operation and clinical staff to resolve issues and escalated problems.
- Acts as informational resource to other departments, staff, members and providers.
- Responsible to assist with workflow coordination within the department.
- Assists manager or director with projects.
- Mentors other staff & assists with coaching when necessary.
Minimum Resource Qualifications: - RN with valid and current NYS Nursing Licensure
- Valid NYS drivers license required
- A minimum of four years clinical experience in ambulatory care, community health or home health setting
- Long Term Support Services (LTSS) or Managed Long-Term Care (MLTC) UAS field RN experience preferred.
- Excellent written and verbal communication skills.
- Excellent computer skills and use of measurement/criteria following NYS guidelines.
- Working knowledge of Microsoft Office applications (Word, Excel)
- Strong interpersonal skills.
- Understanding of the basic Utilizations Management aspects of the department
- Provide efficient, effective, and appropriate documentation
- Ability to take on broader responsibilities
- May be asked to participate in some committees
- Broad understanding of multiple areas, including but not limited to UM and CM, Fair Hearings and Appeals/Grievances, within three months of working in position.
- Demonstrates ability to handle complex assignments, difficult members and highly visible issues.
- Must have ability to travel.
Physical Requirements: - Ability to travel across regions.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer: Equal Opportunity Employer. As such, requires all suppliers of temporary staffing resources to affirm the rights of every person to participate in all aspects of employment without regard to race, color, sex/gender, age, disability, religion, creed, citizenship status, national origin, veteran status, military status, marital status, familial status, domestic violence victim status, sexual orientation, gender identity, predisposing genetic characteristic, genetic information, or any other status protected under the law.
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