This is a field based position for a Reassessment Nurse at Senior Health Partners (SHP) who takes independent ownership for self-scheduling reassessment visits at intervals required by the Department of Health (DOH) to determine service needs and continued eligibility; coordinates with Care Management Team (CMT) to maintain a high level of efficient and effective individualized Care Management operations for SHP's managed long-term care plan (MLTCP) and Healthfirst's Personal Care members (PHSP).
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).
Essential Duties and Responsibilities:
· Conducts SAAM (Semi-Annual Assessment of Member) active members every six months to determine service needs and continued eligibility.
· Completes reassessment of service needs at the request of the Care Team, Member's Family/Caregiver to determine if service level(s) need to be adjusted.
· Completes Patient Review Instruments/Screens and all required nursing assessments for active members to determine adjustments/updates in Care Plan and/or to assist with nursing home admission.
· Occasionally needs to perform interim assessments for evaluation of services and/or status changes.
· Takes independent ownership for self-scheduling of reassessment visits at intervals required by the DOH to determine service needs (e.g., home services to support self-care, rehabilitation, prevention) and continued eligibility.
· Completes required documentation and enters data into Delta (NYS DOH Software) and CCMS (CareEnhance Clinical Management Software) systems.
· Coordinates with CMT or HF MM to maintain a high level of efficient and effective individualized Care Management operations for members.
· Serves as a liaison between the member and the Care Management Team; assesses home environment and psychosocial status.
· Engages with CMT to collaboratively plan, develop and/or modify members’ individualized Care Plan(s).
· Accountable for maintaining a paperless work environment, which includes compiling reassessment package requirements and electronic archiving using Sunguard Macess Exp Service Module.
· Handle other duties as assigned with the occasional need to work weekends, overtime and/or from other HF site locations.
· Contribute creative solutions and ownership of daily assignments for seamless communication and systematic completion of routine and special projects while representing SHP in the community.
· Remains current with industry standards as they relate to Medicaid & Medicare.
· Identifies barrier and develops innovation solutions to ensure quality of member care.
· Communicates with home care agencies and CMT providing feedback regarding home care issues and the performance of Contract Nurses and Aides.
· Provides grass roots, community-based training for frail population care including self-care techniques and prevention strategies.
Required: Associate’s degree.
Licenses, certificates, etc.
Required: RN, licensed in New York State.
Work Related Skills and Experience:
Technical Skills :
Intermediate Microsoft Word, Excel, experience using a corporate e-mail system (i.e. Microsoft Outlook, Lotus Notes, etc.) and electronic medical records database. Proficiency in navigating internet browsers, computer hardware, multi-tasking with multiple electronic documentation systems containing PHI, toggling between multiple software systems simultaneously and using security tools such as encryption.
· 1 year of U.S. based field experience.
· 1 year of U.S. based work experience of which at least one year is in one of the following areas:
- Home Care
- Discharge Planning
- Case Management
- Medical Surgical Nursing
· Must be able to determine clinical eligibility, navigate health care systems, organize daily activities and visits and problem-solve difficult/challenging cases.
· Experience must include demonstrated 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 with an electronic shared network database and archival system to manage patient health information (PHI).
· Independent thinker with excellent communication, interpersonal and decision-making skills for frequent interaction with clients/families/support to communicate outcome of assessments and for daily interactions with Care Teams to discuss scheduling, ongoing member requirements and plans of care.
· Position requires travel within the tri-state area, but primary throughout the 5 boroughs and reports to the headquarters location in lower Manhattan.
· Own car, possess a valid driver's license and proof of insurance.
· Understanding of and sensitivity to cultural differences and needs of the community are essential.
· 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 a frail adult population.
· Knowledgeable of the values offered with integrated care.
· Efaxing and electronic archiving skills.
While performing the duties of this job, this employee will be occasionally climbing, crouching, reaching, bending, overhead lifting, standing, driving and lifting/carrying and pushing and pulling 1-20lbs. This employee will also be frequently walking, keying, traveling and lifting/carrying and pushing/pulling 1-10lbs.
Work Environment :
This employee will be frequently indoors and outdoors.
· Exposure to odors, fumes, infections, dirt and other undesirable conditions may occur.
· There will be an occasional necessity to maintain a calm and even disposition even during the handling of crisis situations.
· Able to follow protocols and use common sense to escalate situations to management and clinical staff appropriately.
· Attention to managing many details and remaining focused in an environment with distractions is needed to be successful.
· The demands of this position are high and fast-paced with firm deadlines and protocols with varied care needs of Members in the management of a frail population in a community setting.
· Regularly communicates moderately 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 software (such as Word and Outlook).
Healthfirst offers a comprehensive benefits package including, but not limited to:
· Basic Life and Accident Insurance
· Supplemental Life insurance
· Dependent Life Insurance
· Short-Term Disability
· Buy-Up Short Term Disability
· Long-Term Disability
· Flexible Reimbursement Accounts
· Healthfirst 401(k) Plan
· Employee Assistance Plan
· Commuter Savings Program
· Eligibility for Annual Bonuses
· Generous Paid Time Off program
· Paid Candidate Referral Program
Conditions of Employment: Employee must pass pre-employment screening which includes a background check and drug testing. Employee must present documentation to verify minimum of high school educational requirement.
Disclaimer: The statements herein are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, national origin, disability or veteran status .
Healthfirst - 17 months ago
Healthfirst is a not-for-profit managed care organization sponsored by some of the most prestigious and nationally recognized hospitals and...