Job Description:

Summary: Ability to review health status questions and make evaluations and determinations based on UAS criteria for enrollment; ability to work with technology in the workplace;  knowledge of the theory, principles, and practices of general professional nursing; knowledge of state and agency laws and regulations governing general professional nursing practices; excellent organizational, interpersonal, written, and verbal communication skills; ability to communicate and work effectively with multi-generational consumers; ability to demonstrate sensitivity to the concerns of others; ability to perform comfortably in a fast-paced, deadline-oriented work environment; ability to successfully execute many complex tasks simultaneously; and a strong ability to work independently.

Responsibilities:

• Perform initial in-home pre-evaluation of patients that includes evaluation of health status, strengths, care needs, and preferences and guides the development of individualized long term care service plans
• Review consumer medical documentation and or health referral forms, as relevant to the case
• Enter evaluation data into electronic evaluation form and transmit, as required
• Document any concerns, conflicting information, other issues that surface during the evaluation process
• Emphasize continuity of care, thus reducing or eliminating fragmentation, duplication, and gaps in treatment plan
• Discuss with consumer on health care options, supports needed, service vendor options and waiver options
• Initiate communication between the Call Center and eligible consumers for enrollment into a managed care health plan
• Enhance communication and collaborative relationships with interdisciplinary care team members to improve care coordination and facilitate service delivery
• Collect quality review data and any required documentation to support outcome measurements and record case notes into CRM
• Identify opportunities for health promotion and illness prevention
• Maintain a comprehensive working knowledge of community resources, payor requirements, and network services for target population
• Meets all standards established for this position as outlined in the corresponding annual performance criteria and bonus template for this position.
• Performs other duties as may be assigned by the Regional Nurse Manager or other project management.

Required Experience-

• 1-2 years of experience in a HOME setting within the last ten (10) years.
• At a minimum, successful candidates must have recent experience conducting comprehensive assessments of patients

Qualification: Two (2) years of experience in a HOME setting within the last ten (10) years; this may include:

• Working in the field for a Certified Home Health Agency (CHHA), Licensed Home Care Service Agency (LHCSA), or Managed Long-Term Care (MLTC)
• Conducting assessments that are similar to the UAS such as OASIS
• Providing primary care to homebound persons
• Care management for persons receiving home and community-based services including Hospice and Assisted Living
• Home care experience as a paraprofessional (e.g., Home Health Aide) or Licensed Practical Nurse

PREFERED: In addition to meeting the required qualifications, the additional experience represents the gold standard candidate for this position.

• Experience conducting assessments in UAS-NY (role 40 or 45), especially in the last 365 days.  
• Experience caring for a geriatric population and managing their chronic diseases, especially in the home setting.

OTHER: The following are examples of experience that may count toward preferred qualifications, but does not satisfy the required qualifications on their own

• Home care experience with only one patient (i.e., private duty nursing)
• Case management that is limited to utilization reviews for a health plan or a combination of hospital and health plan case management.
• Assessments that were all conducted telephonically and did not involve going into the home.   

Certification/Licenses: Current RN Licensure in New York State