Intake Nurse at New York

Job Description

This is a field based RN position. The nurse will conduct enrollment assessments to determine clinical eligibility for the SHP Managed Long-Term Care Plan (MLTCP) and/or Healthfirst Complete Care (CC) programs by conducting functional assessments of clients in the home and preparing assessment documents and developing initial plans of care.

Frequently communicates complex information and interacts through electronic documentation/tools. This is a paperless work environment requiring daily hands-on administration of multiple electronic Patient Health Information (PHI) databases and security requirement tools such as encryption. These systems include, but are not limited to, CCMS (CareEnhance Clinical Management Software), Sunguard Macess Service Module (electronic archiving), RightFax, VoIP, Virtual Work Platforms (using VPN), scanning and creating .pdf files (Adobe Acrobat), and MS Office 2010 software (such as Word and Outlook).

• Conducts enrollment assessments of prospective members in their homes; makes enrollment decisions and develops initial plans of care by utilizing clinical expertise and critical thinking skills.
• Contribute creative solutions and ownership of daily assignments for seamless communication and systematic completion of routine and special projects while representing SHP/CC in the community.
• Remains current with industry standards as they relate to Medicaid & Medicare guidelines.
• Identifies barrier and develops innovative solutions to ensure quality of member care.
• Remains current with industry standards as they relate to Medicaid & Medicare guidelines.
• Identifies barrier and develops innovative solutions to ensure quality of member care.
• Determines clinical eligibility of prospective members following guidelines of MLTCP regulations.
• Completes required paperwork and documentation needed to fulfill enrollment requirements to NYSDOH and SHP/CC management teams using demonstrated ability to translate assessments into written reports. Enters documentation/PHI into various electronic systems including SHP EMR, DELTA, MACCESS, Right Fax.
• Assist as a preceptor for all new employees.
• Handle other duties as assigned with the commitment to work two (2) Saturdays a month on a rotating schedule.
• Communicates with families, caregivers, physicians and community providers regarding SHP/CC MLTCP services and service plans, completes required documents and coordinate home visits as needed. Ensures that prospective members and significant others/responsible parties understand and are in agreement with enrollment in a managed long-term care plan.
• Conducts assessments in settings other than home as needed, e.g. skilled nursing facilities.
• Represents SHP/CC MLTCP in the community and supports education of community providers, families and prospective enrollees in MLTCP services. Assists in developing innovative methods of documentation and record-keeping.

Minimum Qualifications:

• Associates Degree in Nursing and NYS RN license.
• Must have own car, possess and maintain a valid drivers license and auto insurance in your name; proof of all is required.
• Be able to travel within the 5 boroughs as assigned. This position reports to the headquarters location in lower Manhattan.
• A minimum of 1 year of U.S. based experience of which at least one year is in one of the following areas:

- Geriatrics
- Home Care
- Discharge Planning
- Case Management
- Medical Surgical Nursing

• Unexpired NYS drivers license or NYS non-drivers license ID (DMV Identification). If residing outside of NYS, candidate must obtain a NYS non-drivers ID before commencement of employment.
• State registration with the Uniform Assessment System (UAS) for long-term care in NY State is required to access for training, testing and system usage. Upon completion of UAS training, the State will administer testing online. If a passing score is not achieved, the State will allow the individual to retake the test once. The UAS access is a necessity for this position, so employment is contingent on acceptance and continued authorization by the State to have UAS access.
• Proficiency in navigating the Internet and multi-tasking with multiple electronic documentation systems simultaneously.
• The ability to troubleshoot or explain basic hardware and software errors and work with a Technician remotely to perform step-by-step repairs.
• Proficiency with a Corporate email system including using and sharing calendar rights. Intermediate skill level with MS Word, MS Excel and electronic patient health information (PHI) database usage (medical records database). Excel skills with the ability to edit, search, sort/filter, format/use styles are required.
• Able to determine clinical eligibility, navigate health care systems, organize daily activities and home visits, coordinate daily work with enrollment specialists and problem-solve difficult/challenging cases. Note: RN is not scheduling their own visits.
• Independent thinker with excellent communication, interpersonal and decision-making skills for frequent interaction with clients/families/care giver support to communicate outcome of assessments and for daily interactions with Care Teams to discuss scheduling, ongoing member requirements and plans of care.
• Commitment to work on Saturday (twice per month on a rotating schedule) and occasionally additional hours outside of core schedule.
• While performing the duties of this job, this employee will be occasionally lifting/carrying and pushing/pulling 1-20lbs.

Preferred Qualifications:

• Bilingual in speaking in English and Spanish, Russian, French, Creole, Mandarin, Shanghainese, Suzhou, Cantonese, Toishanese, Fujianese, Fukanese, Fuzhounese Hindi, Bengali, Urdu or Nepali.
• Basic efaxing and electronic archiving.
• A minimum of 1 year of U.S. based field experience.
• Experience with multiple Medicaid managed care plan products such as Family Health Plus (FHP), Eastern Benefits System (EBS), Federal Employee Program (FEP).
• Experience working with frail adult or elderly populations.
• Demonstrated ability to determine appropriate plans of care for frail elderly clients, as well as, negotiate initial service plans so that clients and families are in agreement and identify appropriate services that are needed.

*LI-BM1

Job Requirements

 
Country: USA, State: New York, City: New York, Company: Healthfirst.