Job Ref: 54673
Category: Utilization Review and Case Management
Department: MANAGED LONG TERM CARE
Location: 160 Water St. #3, New York, NY
Job Type: Regular
Employment Type: Full-Time
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 is 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 Assessment Nurse completes the UAS assessment tool 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 & PCS 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 & PCS program enrollees.
- Conducts a minimum of 15 UAS assessments on a weekly basis which may include initials, significant change in condition, return assessments and/or semi-annual/re-assessments.
- Conducts “pop-up/drive-by” visits for members/applicants who are unable to reach via phone or family member; these visits are scheduled around the expected minimum UAS assessment per week and will not change the completion rate expectations.
- Scores the Attendant Care worker tasking tool and shares potential hours and daycare services with applicant and family
- Discusses other options for applicants that do not meet the clinical qualifications for the MLTCP.
- Reviews 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 request re-assessment due to change in condition of the member.
- Participates in MetroPlus quality management activities related to MLTC & PCS as needed.
- Provides information to the MLTC and PCS management teams
- Performs other tasks assigned by the MLTC & PCS management teams
- Bachelor’s Degree (BSN) required
- A minimum of two (2) to three (3) years clinical experience in Certified Home Health Agency (CHHA), Lombardi program and MLTC experience.
Licensure and/or Certification Required
- Registered Nurse, Currently New York State license
- UAS Certified RN required
- Integrity and Trust
- Customer Service Focus
- Functional/Technical skills
- Written/Oral Communications
- Basic working knowledge of computer systems.
- Excellent communications, written and analytical skills.