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    uas assessment nurse, ltss - New York, NY , USA, United States - AdvantageCare Physicians

    AdvantageCare Physicians
    AdvantageCare Physicians New York, NY , USA, United States

    1 week ago

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    Description

    Summary of Job:
    Assess eligibility of members in need of community based long term support services (CBLTSS). Conduct UAS assessment in the members home or by telehealth (under NY State's regulations), and at skilled nursing facilities. Consult with health care providers to support assessment outcomes. Conduct needs assessment utilizing the UAS-NY/DOH tool to determine members' qualification for Long Term Care services. Complete the Community Health Assessment (CHA) Variance Resolution process (clinical disputes).


    Responsibilities:

    • Conduct quality assurance review of completed UAS assessments in UAS-NY database for EmblemHealth members.
    • Comply with NY State DOH guidelines on completion and timely finalization of all UAS assessments.
    • Collaborate with member, caregiver, Maximus, and the plan to ensure three-way calls are completed for initial and expedited assessments.
    • Submit completed assessments timely to EmblemHealth, completing member correspondence with quality and efficiency.
    • Maintain knowledge of all applicable NYSDOH/CMS guidelines and relevant organizational and departmental policies and procedures.
    • Escalate questions or concerns during the program assessment and enrollment process to the leadership team and or NYIA to ensure proper completion of UAS-NY and handling of issues that may require intervention.
    • Support an integrated care model tapping into appropriate resources both internally and external to the organization.
    • Enter and maintain documentation in the Electronic Medical Records System (EMR), meeting defined timeframes and performance standards.
    • Maintain an understanding of Care Management principles, program objectives and design, implementation, management, monitoring, and reporting.
    • Actively participate on assigned committees and meetings to support LTSS program functions.
    • Attend and complete all department-mandated training as well as satisfy educational in-service requirements.
    • Perform other related projects and duties as assigned.
    • Act as the member's advocate and liaison by completing or facilitating interventions with providers and/or private, non-profit, and governmental agencies.

    Qualifications:

    • Associate or Baccalaureate degree in nursing
    • Active New York State Registered Nursing (RN) license in good standing
    • UAS-NY certification
    • One year experience in MLTC, LTSS or home care (Preferred)
    * years of relevant, professional nursing experience (Required)

    • Experience with NYSDOH Medicaid program requirements and benefits under Long Term Care Proficiency in utilizing and analyzing UAS-NY assessments and assessment outcomes (Required)
    • Organization/prioritization ability; and the ability to effectively manage a caseload of highly complex members (Required)
    • Experience with Long-term Services and Supports (LTSS), Managed Long Term Care (MLTC) (Required)
    • Strong communication skills (verbal, written, presentation, interpersonal) (Required)
    • Computer proficiency: MS Office (Word, Excel, Outlook, TEAMS); mobile technology (wireless phone/laptop, etc.) (Required)
    • System user experience in a highly automated environment (Required)
    • Strong cross-group collaboration, teamwork, problem solving, and decision-making skills (Required)
    • Ability to work a flexible schedule (evenings, weekends, and holidays) to meet member and/or caregiver and departmental scheduling needs (Required)
    • Ability to conduct field-based and telehealth assessments (50% in field, 50% telephonic) (Required)
    • Ability to complete 2-3 assessments per day (Required)
    Additional Information


    • Requisition ID:
    • Hiring Range: $63,000-$110,000
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