Community Health Assessment Field Nurse (RN)
: Job Details :

Job Description: Summary: 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 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.• 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.• Performs other functions as assigned by management.Minimum Qualifications:• 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, 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.• Understanding of the basic Utilization Management and Case Management aspects of the department • 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.Physical Requirements:• Ability to work prolonged periods driving, sitting and/or standing at a workstation and working on a computer.• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.• Ability to work in a home office for continuous periods of time for business continuity.• Ability to travel across the Health Plan service region for daily work assignments, meetings and/or trainings as needed.• Ability to lift, carry, push, or pull 15 pounds or less.• Manual dexterity including fine finger motion required. • Repetitive motion required.• The ability to hear, understand, and speak clearly while using a phone, with or without a headset.• Must have a valid Class D license and ability to operate a motor vehicle. • Must have reliable motor vehicle available.One Mission. One Vision. One I.D.E.A. One you.Together we can create a better I.D.E.A. for our communities.At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know diversity helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating our employees' experiences, skills, and perspectives, we take action toward greater health equity. We aspire to reflect the communities we live in and serve, and strongly encourage people of color, LGBTQ+ people, people with disabilities, veterans, and other underrepresented groups to apply.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 EmployerCompensation Range(s):Grade 207: Minimum $60,070 - Maximum $111,114The 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.