- This position is hybrid and will support the Bronx area in New York City. The position requires attending and conducting assessments in consumer homes and through a telehealth modality.
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Perform remote telehealth and in-home evaluations of individuals seeking long term care services and supports. Evaluations include a determination of health status, strengths and care needs.
- 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
- Active RN license required.
- RN license in the state of New York
- 2+ years' experience working in-home setting within the last 10 years
- Candidates must have their own cell phone
- Maximus provides company-issued computer equipment
- Reliable high-speed internet service
- Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity
- Minimum 5 Mpbs upload speeds
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Description
& RequirementsMaximus is currently hiring hybrid remote Registered Nurse (RN) UAS-Assessors to support the New York Independent Assessor Program (NYIAP).
The New York Independent Assessor Program serves the State of New York by conducting UAS assessments to determine eligibility for community-based long-term services.
The Registered Nurse Assessor will bring robust qualifications and a strong desire to contribute their knowledge and expertise to a meaningful program.
This position is the front line ensuring consistent and accurate assessment are completed in a telehealth or in-home setting.Essential Duties and Responsibilities:
Minimum Requirements:
Home Office Requirements:
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce.
We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer.Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.
Pay Transparency
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off.
Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.
