11 Community Health Assessment Field Nurse (RN) at Excellus Health Plan Inc. Jobs in Rochester, NY
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Community Health Assessment Field Nurse (RN) at Excellus Health Plan Inc.
$68k-85k (estimate)
Full Time
2 Weeks Ago
Health eCareers is Hiring a Community Health Assessment Field Nurse (RN) at Excellus Health Plan Inc. Near Rochester, NY
Job DescriptionSummary: This position is responsible conducting face to face assessment of members in their home and/or facility. The incumbent utilizes required NYS Community Health Assessment (CHA) Tools to determine functional status, medical, behavioral, psychological, and community resource needs for coordinating, integrating, and monitoring the use of medical and health care services for members. The SN CHA Nurse may also perform other technical and administrative tasks essential to the efficient operation of the department.
This role requires travel -70-75% of the time across New York State- the regions we serve. Essential AccountabilitiesConducts face to face assessment of members utilizing required NYS UAS Assessment Tools, and/or other tools as directed by NYS or other regulatory bodies, to determine functional status, medical, behavioral, psychological, and community resource needs, as well as member's level of work capacity and related restrictions/limitations.
Collaborates with interdepartmental teams and external stakeholders, if necessary, to assist in the development of Person-Centered Service Plan. Clarifies benefits, policies, and procedures for current members, providers, and community-based agencies.
Assesses, plans and implements care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care.
Identifies social service programs; including financial, psychosocial, community and state supportive services available to augment the need for LTSS services.
Refers appropriate cases to governmental agencies (e. g. APS/CPS) as needed, and any suspected/possible Medicaid fraud to the Special Investigations Unit (SIU) or designated internal/external entity.
Communicates with all internal and external stakeholders to obtain the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members.
Adheres to all Corporate and Departmental policies and ensures all regulatory requirements such as DOH, CMS, Medicaid, and accreditation requirements such as NCQA, URAC and HEDIS functionalities are met or exceeded. Accesses Health Commerce System (HCS) and complete/maintain all mandatory trainings as required.
May be required to attend Fair Hearings with Medical Director relating to specific cases.
Works independently, as well as collaboratively, with members and internal/external stakeholders, resulting in improved member health.
Identifies, recommends and assesses new processes as necessary to improve productivity and gain efficiencies. Assists in updated departmental policies, procedures and desk-top manuals relative to their function.
Serves as subject matter expert and occasionally works directly with the operation and clinical staff to resolve issues and escalated problems.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct and Leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.
Regular and reliable attendance is expected and required.
Minimum QualificationsPerforms other functions as assigned by management.
RN with valid and current NYS Nursing Licensure.
Minimum of four years clinical experience in ambulatory care, community health or home health setting.
Minimum six months experience in Long Term Support Services (LTSS) or Managed Long-Term Care (MLTC) CHA field RN experience required.
Broad understanding of multiple areas, i
Compensation Information$0.0 / - $0.0 /
Starting At: 0.0
Up To: 0.0
This role requires travel -70-75% of the time across New York State- the regions we serve. Essential AccountabilitiesConducts face to face assessment of members utilizing required NYS UAS Assessment Tools, and/or other tools as directed by NYS or other regulatory bodies, to determine functional status, medical, behavioral, psychological, and community resource needs, as well as member's level of work capacity and related restrictions/limitations.
Collaborates with interdepartmental teams and external stakeholders, if necessary, to assist in the development of Person-Centered Service Plan. Clarifies benefits, policies, and procedures for current members, providers, and community-based agencies.
Assesses, plans and implements care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care.
Identifies social service programs; including financial, psychosocial, community and state supportive services available to augment the need for LTSS services.
Refers appropriate cases to governmental agencies (e. g. APS/CPS) as needed, and any suspected/possible Medicaid fraud to the Special Investigations Unit (SIU) or designated internal/external entity.
Communicates with all internal and external stakeholders to obtain the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members.
Adheres to all Corporate and Departmental policies and ensures all regulatory requirements such as DOH, CMS, Medicaid, and accreditation requirements such as NCQA, URAC and HEDIS functionalities are met or exceeded. Accesses Health Commerce System (HCS) and complete/maintain all mandatory trainings as required.
May be required to attend Fair Hearings with Medical Director relating to specific cases.
Works independently, as well as collaboratively, with members and internal/external stakeholders, resulting in improved member health.
Identifies, recommends and assesses new processes as necessary to improve productivity and gain efficiencies. Assists in updated departmental policies, procedures and desk-top manuals relative to their function.
Serves as subject matter expert and occasionally works directly with the operation and clinical staff to resolve issues and escalated problems.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct and Leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.
Regular and reliable attendance is expected and required.
Minimum QualificationsPerforms other functions as assigned by management.
RN with valid and current NYS Nursing Licensure.
Minimum of four years clinical experience in ambulatory care, community health or home health setting.
Minimum six months experience in Long Term Support Services (LTSS) or Managed Long-Term Care (MLTC) CHA field RN experience required.
Broad understanding of multiple areas, i
Compensation Information$0.0 / - $0.0 /
Starting At: 0.0
Up To: 0.0
Job Summary
JOB TYPE
Full Time
SALARY
$68k-85k (estimate)
POST DATE
08/29/2024
EXPIRATION DATE
09/26/2024
WEBSITE
healthecareers.com
HEADQUARTERS
Denver, CO
SIZE
100 - 200
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