Safety Net UAS Field Registered Nurse at Excellus Health Plan Inc. in Rochester, New York

Job Description:

Job Description:

Summary:

This position is responsible conducting face to face assessment of members in their home and/or facility. This is accomplished by utilizing required NYS UAS Assessment 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 UAS Nurse may also perform other technical and administrative tasks essential to the efficient operation of the department.

Essential Primary Responsibilities/Accountabilities:

• Conducts 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


• May be required to attend Fair Hearings with Medical Director relating to specific cases.


• Attends departmental meetings, as required.


• Works independently, as well as collaboratively, with members and internal/external stakeholders, resulting in improved member health.


• Manages complex assignments.


• Serves as a positive role model to others in the department.


• 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.


• Process Management and Documentation -


• 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 if called upon, works directly with the operation and clinical staff to resolve issues and escalated problems.


• Acts as informational resource to other departments, staff, members and providers.


• Responsible to assist with workflow coordination within the department.


• Assists manager or director with projects.


• Mentors other staff & assists with coaching when necessary.


• 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.


• Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.


• Regular and reliable attendance is expected and required.


• Performs other functions as assigned by management.

Minimum Qualifications:

• RN with valid and current NYS Nursing Licensure


• Valid NYS driver's license required


• A minimum of four years clinical experience in ambulatory care, community health or home health setting


• Long Term Support Services (LTSS) or Managed Long-Term Care (MLTC) UAS field RN experience preferred.


• Excellent written and verbal communication skills.


• Excellent computer skills and use of measurement/criteria following NYS guidelines.


• Working knowledge of Microsoft Office applications (Word, Excel)


• Strong interpersonal skills.


• Understanding of the basic Utilizations Management aspects of the department


• Provide efficient, effective, and appropriate documentation


• Ability to take on broader responsibilities


• May be asked to participate in some committees


• Broad understanding of multiple areas, including but not limited to UM and CM, Fair Hearings and Appeals/Grievances, within three months of working in position.


• Demonstrates ability to handle complex assignments, difficult members and highly visible issues.


• Must have ability to travel.

Physical Requirements:

• Travel -70-75%

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The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Grade 206: Minimum $58,500 - Maximum $93,267

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.