Job Ref: 45513
Category: Utilization Review and Case Management
Department: MANAGED LONG TERM CARE
Location: New York, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $93,866.00
Salary Range: $93,866.00 - $93,866.00
MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
The Assessment Nurse if the first person that the potential member/member and family meet from the MLTC & FIDA programs. The Assessment Nurse conducts the UAS assessment to determine the level of care needed to support applicants/members in the own homes. The incumbent will complete the UAS assessment tools and makes the determination if an applicant is appropriate for the MetroPlus MLTC program. The Assessment Nurse also completes the UAS assessment tool on members already enrolled in the MLTC & FIDA programs upon program enrollment, semi-annually and when there is a significant change in condition.
- Meets with applicant, family and caregiver to determine if MLTC program applicants meet the clinical qualifications for enrollment. (i.e.; UAS score 5 or greater, needing 120 days of care, safe in home environment).
- Meet with member, family and caregiver to conduct the UAS tool for MLTC & FIDA program enrollees.
- Conducts all assessment needed based on UAS tool.
- Scores the Attendant Care Worker tasking tool and shares potential hours and daycare services with applicant and family.
- Discusses other for applicants that do not meet the clinical qualifications for the MLTCP.
- Review handbook and enrollment documents with applicants who meet the criteria for enrollment in the MLTCP. Responds to questions and obtains signature on all necessary documents.
- Reviews findings of assessments and interviews with applicant and family with Care Manager.
- Conducts reassessments of member pursuant to schedule and in cases when Care Manager requests re-assessment due to change in condition of the member.
- Participates in MetroPlus quality management activities related to MLTC & FIDA as needed.
- Provides information to the MLTC & FIDA management teams.
- Performs other tasks assigned by the MLTC & FIDA management teams.
- Bachelor’s Degree (BSN) preferred
- Two (2) to three (3) years clinical experience in certified home health agency (CHHA), Lombardi program and/or MLTC
Licensure and/or Certification Required
- Registered Nurse, Currently New York State license
- UAS Certified RN
- Integrity and Trust
- Customer Service Focus
- Functional/Technical skills
- Written/Oral Communications
How To Apply
If you wish to apply for this position, please apply online by clicking the "Apply Now" button or forward your resume, noting the above Job ID #, to:
MetroPlus Health Plan
Human Resources Department
160 Water Street 8th Floor
New York, NY 10038
Attn: Recruitment Unit