Job Summary
Responsible for the completion Community Health Assessment (CHA) formerly the UAS (Uniform Assessment System) Initial Assessments and Reassessments based on New York State requirements, guidelines, and training provided by the company and/or outside resources; enrollment paperwork materials required to appropriately process members’ application for enrollment, and CHA Tasking Tool based on guidelines and training provided by the company and/or outside resources. Responsible for corrections and revision of CHA paperwork and tasking tool documentation based on review and feedback provided through quality and associated review process.
Knowledge/Skills/Abilities
• Completes approved New York State Comprehensive Health Initial Assessment Tool and/or Clinical Reassessment used to define eligibility for community based long term care services; develops plan of care for members
• Completes enrollment paperwork, progress notes and tasking tool in members’ home to assist in determining eligibility for services; reviews all data collected for accuracy and completion prior to submission
• Charts all contacts and findings within appropriate tool and form per policy and procedure within deadlines
• Attends training and continuing education sessions focused on the proper completion of Comprehensive Health Assessment documentation, enrollment paperwork, and tasking tool.
• Focuses on continuous improvement and quality excellence in the completion of all material associated with the initial enrollment/continued enrollment of members in the plan
• Supports initiatives of the Quality Assessment and Performance Improvement Committee
• Trained and knowledgeable in the NY UAS. Ability to understand and apply principles of Care Management and Person-Centered Planning
• Solid assessment skills
• Ability to understand and apply coverage guidelines and benefit limitations
• Familiar with clinical needs and disease processes for chronic physical and behavioral illnesses
• Understands and adapts appropriately to issues related to communication, cognitive or other barriers
• Strong organizational skills and the ability to prioritize and follow through on multiple projects in a timely manner
• Must be able to travel to multiple boroughs via car or commuting via public transportation
• Basic computer skills
Job Qualifications
Required Education:
• Associates degree in Nursing
Required Experience:
• Minimum two years clinical experience with focus in managed care, including disease or case management
• UAS experience
• Experience conducting home visits
Required Licensure or Certification:
• Registered Nurse (RN)
State Specific Requirements:
• Must reside in the state of NY or neighboring states (NJ, CT, parts of PA). Must have a NY state government ID
Preferred Qualifications: Provide any preferred education, experience, licensure or Knowledge, Skills and Abilities
Preferred Qualifications:
• Bachelor’s degree in Nursing
• CCM- Certified Case Manager, CCP – Chronic Care Professional.
• Home Care, Long-Term Care, MLTC experience, including appropriate support services in the community and accessing and using durable medical equipment (DME).
• Experience in utilization review, concurrent review and/or risk management a plus.
• Bilingual or multi-lingual.
• Health Commerce User Role 40
Travel Requirements:
Driving: 50%
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.