Job Summary
Provides support for the completion of the Community Health Assessment (CHA) - formerly the UAS (Uniform Assessment System), initial assessments and reassessments based on New York state requirements, guidelines, and training provided by the company and/or outside resources. Completes enrollment paperwork materials required to appropriately process member applications for enrollment and CHA tasking tool in alignment with guidelines and training provided by the company and/or outside resources. Facilitates correction and revision of CHA paperwork and tasking tool documentation based on review and feedback provided through quality/review process.
This position is member facing and requires visits to members at their home or facility.
Job Duties
- Completes approved New York State initial assessment tool and/or clinical reassessment used to define eligibility for community-based long-term care services for members.
- Completes enrollment paperwork, progress notes and tasking tool in member homes to assist in determining eligibility for services; reviews all data collected for accuracy and completion prior to submission.
- Charts all contacts and findings within appropriate tool and form per policy and procedure and within established deadlines.
- Attends training and continuing education sessions focused on the proper completion of Comprehensive Health Assessment (CHA) documentation, enrollment paperwork, and tasking tool.
- Focuses on continuous improvement and quality excellence in the completion of all materials associated with the initial enrollment/continued enrollment of members in the plan.
- Supports initiatives of the quality assessment and performance improvement committee.
- Performs daily local travel in the assigned local territories (based upon state/contractual requirements).
Job Qualifications
Required Qualification
- At least two years of clinical experience in managed care - including case management and home visit experience, or equivalent combination of relevant education and experience.
- Registered Nurse (RN). License must be active and unrestricted in state of practice.
- Must reside in the state of New York or neighboring states (NJ, CT, parts of PA). Must have a NY state government ID.
- Trained and knowledgeable in the New York Uniform Assessment System (UAS).
- Must be able to travel to multiple boroughs via car or commuting public transportation.
- Understands and applies principles of care management and person-centered planning.
- Solid assessment skills.
- Understands and applies coverage guidelines and benefit limitations.
- Familiar with clinical needs and disease processes for chronic physical and behavioral illnesses.
- Understands and adapts appropriately to issues related to member communication, cognitive or other barriers.
- Organizational skills, and ability to prioritize and follow through on multiple projects in a timely manner.
- Effective verbal and written communication skills.
- Microsoft Office suite and applicable software programs proficiency.
Preferred Qualification
- Certified Case Manager (CCM) or Chronic Care Professional (CCP).
- Home care or long-term care experience.
- Community support service experience accessing and using durable medical equipment (DME).
- Experience in utilization review, concurrent review and/or risk management.
- Bilingual or multi-lingual.
- Ability to commute as needed to meet with members in person at their home or facility.
Pay Range: $24 - $56.17 / HOURLY