Job Responsibilities:

·       Works closely with intake and enrollment and care delivery teams regarding in-home or virtual assessment appointments with prospective or enrolled participants (utilizing the Uniform Assessment System of New York, UAS-NY). During this visit, answers questions about the PACE program and emphasizes the unique benefits of the PACE program.

·       Conducts in-home assessments for PACE participants utilizing the UAS-NY to determine initial or continued plan eligibility by the requirement need of Community Based Long Term Care (CBLTC) Services for greater than 120 days, and care needs.

·       Evaluates and reviews previous assessments (of all types) to ensure documentation of any/all changes are accurately reflected in EMR. Must include narrative

comments and supporting documentation and escalate issues of significant changes to Care Delivery to provide corrected resources.

·       Evaluates and reviews previous primary diagnosis and medications at key intervals to ensure updated documentation is accurately reflected in EMR and match the

diagnosis entered into UAS. Update and/or modify diagnosis codes and medication updates and ensure the accuracy of information. Must include narrative comments

and supporting documentation and escalate issues of changes to ensure proper care and management of cases are followed.

·       Promotes and educates potential referral sources about the PACE program as needed to encourage participation in the program through presentations, lectures, meetings, or other support.

·       Educates potential/new PACE participants on plan benefits, services, and care delivery model.

·       Escalates questions or concerns during the assessment to the quality review team to ensure appropriate completion of UAS-NY and handling of on-site issues that may

require intervention.

·       Completes and/or reassesses previous PCAT Tasking Tool to determine appropriate home assistance with ADLs/IADLs combined with attendance. Evaluates and provides recommendations for modifications, corrections, and/or changes to previous evaluations, as well as escalates issues to the

discipline manager.

·       Develops the proposed service plan and obtain necessary documentation during home visits.

·       Utilizes Lenavi analyzer during either the review process and/or assessment.

·       Documents all interactions and outcomes in the designated clinical management/electronic record system.

·       Completes all assessments, notes, service plans, and other documentation timely (within 48 hours).

·       Works with the quality review team to ensure the accuracy and completeness of all necessary documentation in the Health Commerce System and the electronic record

system.

·       Maintains knowledge of all applicable CMS/PACE guidelines and relevant organizational and departmental policies and procedures, including but not limited to, the timely conduction, finalization, and documentation of the UAS-NY.

·       Must able to work some weekends and ability to travel to various boroughs.

·       Provides significant clinical information to the Care Delivery team in advance of enrollment to ensure a smooth transition and appropriate opportunity for Care Delivery preparation of new participants with complex health conditions.

·       Partners with Care Delivery by meeting with site leadership and IDT to provide Clinical Assessment and Intake updates, address concerns and improve the overall

process.

·       Serves as clinical point person in response to Care Delivery questions, concerns, or issues after enrollment.

·       Engages in continuous quality improvement activities to promote optimal staff performance and participant outcomes.

·       Advises on operational process improvements that may positively impact enrollment turnaround, scheduling logistics, expense/financial-related efficiencies, engagement strategies, reporting, and other critical touchpoints.

·       Regularly reviews key performance metrics and analytics to improve process flows and/or quality of work.

·       Only acts within the scope of the individual’s authority to practice.

·       Meets a standardized set of competencies for the specific position description established by the PACE organization before working independently.

Schedule:

8:30AM – 5:30PM Weekly Hours: 40

Qualifications:

Education:

BS in Nursing or other health-related area, preferred.

Minimum of one (1) year of experience working with a frail or elderly population or, if the individual has less than one (1) year of experience but meets all other requirements, must receive appropriate training from the PACE organization on working with a frail or elderly population upon hiring.Three to five (3-5) years in MLTC, LTHHCP, MAP, PACE, or other managed care programs.Experience in working independently without significant oversight and or direction from a supervisor.Minimum of five (5+) years of experience in care/case management, disease management, population health management, utilization review, quality assurance, or discharge planning (preferably within a managed care, home care, or community health organization).Proficiency in utilizing and analyzing UAS-NY and Lenavi.Experience with Customer Relationship Management platforms and clinical management systems

License:

Current active and unrestricted license in NYS as a Registered Nurse, required.

Language:

Bilingual skills are strongly preferred.

 

Pay and Benefits

The pay range for this position is $120000.00 - $125000.00/yr.

Benefits:
Medical/Dental/Vison insurance through United Healthcare
403(b) retirement plan with employer match
Commuter transit and parking plans
FSA
DCA
HRA
HSA
EAP
Discretionary PTO

Workplace Type

This is a fully onsite position in White Plains,NY.

Application Deadline

This position is anticipated to close on Mar 7, 2025.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

Hiring diverse talent Maintaining an inclusive environment through persistent self-reflection Building a culture of care, engagement, and recognition with clear outcomes Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.