Geriatrics
Home Care
Discharge Planning
Case Management
Medical Surgical Nursing
Knowledge of health insurance, Medicaid, Medicare and MLTCP

Experience working with a frail adult or elderly population with the ability to determine appropriate care plans and services for frail population as well as negotiate initial service plans so that members and families are in agreement

Experience: Open to individuals without UAS experience (including new grads) but ideal background is from a home based setting or community setting. MUST BE tech savvy, efficient, and comfortable traveling anywhere in the boroughs.

Will be working with a scheduler to coordinate appointments and cancellations but the RN will be tasked with confirming the night before that their candidates are set. Will try to book as close as possible to each other.

Metrics: 12 assessments a week. 3 days a week will see 2 individuals and 2 days a week they will see 3. Typically they are at 9am, 12pm, and 3pm. RNs can document either in the home with the members, somewhere in the community, or at home, but there is a 24 hour deadline to get the assessments into the UAS system.

Reimbursement: RNs will be compensated at 70 cents per mileage for travel between homes (not to the first or from the last). Open to someone who does not have a car if they feel confident they can move around on public transit. If using the subway, they are reimbursed for swipes. Parking is not reimbursed.

Training: 6 weeks of training including a couple of days onsite in the office. Will be shadowing and working with preceptor. The other days, training is remote.

Overview: The Assessment Nurse makes field assessment visits for members or prospective members around downstate New York at intervals required by the Department of Health (DOH) and completes appropriate documentation to determine members’ enrollment, service needs, and continued plan eligibility. This position coordinates with Care Management Team (CMT) to maintain efficient and effective operations of Healthfirst’s long term care plans such as CompleteCare and Senior Health Partners. Strong technological proficiency is essential for this role as the Assessment Nurse must efficiently navigate multiple technology platforms throughout the course of their day.

Duties and Responsibilities:
· Conducts home assessments (and virtual assessments, as needed) for prospective members and re-assessments of current members using the Uniform Assessment System (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and critical thinking skills. As needed, conducts assessments in settings other than home as needed, e.g. skilled nursing facilities or virtually

· Navigates multiple technology/digital platforms such as UAS software, electronic medical records, TruCare, etc., to conduct and document comprehensive assessments accurately and efficiently

· Completes assessment of service needs per CMT and member's family/caregiver’s request to determine service needs or any necessary adjustments

· Reviews previous nursing assessments/medical notes to determine necessary adjustments/updates in Care Plan and/or to assist with nursing home admission

· Conducts in-person Care Management visits in support of person-centered service planning

· Liaisons between the member and the CMT; assesses home environment and psychosocial status

· Provides feedback to home care agencies and CMT regarding home care issues and contract nurses and aides performance

· Provides grass roots, community-based training for frail population care including self-care techniques and prevention strategies

· Ensures (prospective) members and significant others/responsible parties understand and are in agreement with enrollment in a managed long-term care plan

Required Qualifications:
· New York State RN license

· NY state driver’s license or NY state ID

· Ability to travel around downstate New York up to and including the 5 boroughs, Long Island, Rockland, and Westchester.

· Prior work experience requiring technological proficiency including the ability to navigate multiple technology platforms and modalities

· Prior work experience requiring intermediate Microsoft Word, Excel, and Outlook skills

· Prior work experience requiring time management, critical/creative thinking, communication, and problem-solving skills

Preferred Qualifications:
· Work experience using electronic patient health information (PHI) database usage especially UAS

· Previous field-based experience assessing, planning, and evaluating member's care by making home or facility visits for intake/reassessments or start of care (SOC) Community Home Health Agency (CHHA) visits

· Work experience preferred in one or more of the following areas, geriatrics, home care, discharge planning, case management, and/or medical surgical nursing

· Knowledge of health insurance, Medicaid, Medicare and MLTCP

· Experience working with a frail adult or elderly population with the ability to determine appropriate care plans and services for frail population as well as negotiate initial service plans so that members and families are in agreement

· Demonstrated ability handling heavy caseloads

Schedule/Shift: Monday - Friday, 8:30am - 5pm (40 hours a week)

Pay: $55-62/hr

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

^*As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient’s residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.