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Field Nurse Evaluator
4 months ago
**Description & Requirements**
Maximus is currently hiring for a Field Registered Nurse - Home Care to support our C-YES Program. (Children and Youth Evaluation Services).
**This is a full time, hybrid-remote position that will require travel throughout territories of Kingston, Oneonta, Newburgh, and Middletown, New York.**
Maximus has partnered with the New York State Department of Health to establish the Children and Youth Evaluation Service (CYES) program to determine whether a child or youth is eligible for home and community-based services (HCBS) covered by Medicaid. The Field Nurse Evaluator will be working in the community conducting strength-based assessments for families who have children (ages 0-21) with behavioral health/psychiatric issues. All nurses are provided support and education for ongoing professional development and annual certification in the CANS-NY assessment tool. The assessments will be the basis for family-driven Plan of Care (POC) development to support the family's access to Home and Community Based Services (HCBS). The Nurse Evaluator will conduct 1-2 assessments a day and work with a Family Support Coordinator to meet the family's case management needs specifically related to the HCBS POC.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Develop Home and Community Based Services (HCBS) Plan of Care (POC) in collaboration with child and family that includes evaluation of health status.
- Perform initial in-home evaluations of children that includes evaluation of health status, strengths, care needs, and preferences and guide the development of individualized long-term care service plans.
- Review child's medical documentation and or health referral forms, as relevant to the case
- Utilize the State CANS assessment tool and MAXIMUS case management systems to document the child's health status, strengths, care needs, diagnoses and preferences and transmit, as required.
- Properly document any concerns, conflicting information, other issues that surface during the evaluation process
- Emphasize continuity of care, thus reducing or eliminating fragmentation, duplication, and gaps in treatment plan
- Discuss with child/family health care options, supports needed, service vendor options and waiver options.
- Update plans of care as per State requirements, and on an as needed basis
- Collaborate with Family Support Coordinators to meet the needs of the family.
- Enhance communication and collaborative relationships with interdisciplinary care team members to improve care coordination and facilitate service delivery.
- Collect quality review data and any required documentation to support outcome measurements and record case notes into CRM.
- Provide relevant information in response to the child's specific needs as a bridge between when the in-home evaluation is conducted and evaluation results are provided
- Maintain a comprehensive working knowledge of community resources and network services for target population.
- Meets all standards established for this position as outlined in the corresponding annual performance criteria and bonus template for this position.
- Performs other duties as may be assigned by the Regional Manager or other project management
Minimum Requirements
- Active RN license required.
Minimum 2 years clinical experience required with RN license.
- Graduate of an accredited nursing program
- Active RN Licensure in the state of New York
- 2+years relevant experience as an RN
- Active and valid New York driver's license
- Required ability to travel throughout assigned region, based on business needs.
- Must have reliable form of transportation.
- Ability to review health status questions and make evaluations and determinations based on the UAS-CANS-NY system criteria for enrollment; ability to work with technology in the workplace.
- Knowledge of the theory, principles, and practices of general professional nursing
- Knowledge of state and agency laws and regulations governing general professional nursing practices
- Excellent organizational, interpersonal, written, and verbal communication skills
- Ability to communicate and work effectively with multi-generational consumers.
- Ability to demonstrate sensitivity to the concerns of others.
- Ability to perform comfortably in a fast-paced, deadline-oriented work environment.
- Ability to successfully execute many co
