UAS Assessment Nurse, LTSS (NYC Based)
Company: EmblemHealth
Location: New York
Posted on: April 20, 2024
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Job Description:
Summary of Job:
Assess eligibility of members in need of community based long term
support services (CBLTSS). Conduct UAS assessment in the members
home or by telehealth (under NY State's regulations), and at
skilled nursing facilities. Consult with health care providers to
support assessment outcomes. Conduct needs assessment utilizing the
UAS-NY/DOH tool to determine members' qualification for Long Term
Care services. Complete the Community Health Assessment (CHA)
Variance Resolution process (clinical disputes).
Responsibilities:
Conduct quality assurance review of completed UAS assessments in
UAS-NY database for EmblemHealth members.
Comply with NY State DOH guidelines on completion and timely
finalization of all UAS assessments.
Collaborate with member, caregiver, Maximus, and the plan to ensure
three-way calls are completed for initial and expedited
assessments.
Submit completed assessments timely to EmblemHealth, completing
member correspondence with quality and efficiency.
Maintain knowledge of all applicable NYSDOH/CMS guidelines and
relevant organizational and departmental policies and
procedures.
Escalate questions or concerns during the program assessment and
enrollment process to the leadership team and or NYIA to ensure
proper completion of UAS-NY and handling of issues that may require
intervention.
Support an integrated care model tapping into appropriate resources
both internally and external to the organization.
Enter and maintain documentation in the Electronic Medical Records
System (EMR), meeting defined timeframes and performance
standards.
Maintain an understanding of Care Management principles, program
objectives and design, implementation, management, monitoring, and
reporting.
Actively participate on assigned committees and meetings to support
LTSS program functions.
Attend and complete all department-mandated training as well as
satisfy educational in-service requirements.
Perform other related projects and duties as assigned.
Act as the member's advocate and liaison by completing or
facilitating interventions with providers and/or private,
non-profit, and governmental agencies.
Qualifications:
Associate or Baccalaureate degree in nursing
Active New York State Registered Nursing (RN) license in good
standing
UAS-NY certification
One year experience in MLTC, LTSS or home care (Preferred)
4 - 6+ years of relevant, professional nursing experience
(Required)
Experience with NYSDOH Medicaid program requirements and benefits
under Long Term Care Proficiency in utilizing and analyzing UAS-NY
assessments and assessment outcomes (Required)
Organization/prioritization ability; and the ability to effectively
manage a caseload of highly complex members (Required)
Experience with Long-term Services and Supports (LTSS), Managed
Long Term Care (MLTC) (Required)
Strong communication skills (verbal, written, presentation,
interpersonal) (Required)
Computer proficiency: MS Office (Word, Excel, Outlook, TEAMS);
mobile technology (wireless phone/laptop, etc.) (Required)
System user experience in a highly automated environment
(Required)
Strong cross-group collaboration, teamwork, problem solving, and
decision-making skills (Required)
Ability to work a flexible schedule (evenings, weekends, and
holidays) to meet member and/or caregiver and departmental
scheduling needs (Required)
Ability to conduct field-based and telehealth assessments (50% in
field, 50% telephonic) (Required)
Ability to complete 2-3 assessments per day (Required)
Additional Information
Keywords: EmblemHealth, Edison , UAS Assessment Nurse, LTSS (NYC Based), Healthcare , New York, New Jersey
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