Manager of Clinical Outreach and Assessment

1 week ago

New York County New York, United States Prologic Cosulting Inc Full time

POSITION SUMMARY:


The Manager of Clinical Outreach and Assessment is responsible for informing referral sources and potential clients about the Program of All-Inclusive Care for the Elderly (PACE), including the services available and eligibility criteria for Medicare and Medicaid.

This role involves executing outreach initiatives and effectively assisting prospects throughout the onboarding process, contributing to the growth of the organization.

The individual will perform clinical evaluations using the Uniform Assessment System of New York (UAS-NY) and will record clinical and enrollment details in the electronic documentation system.

This position also plays a crucial role in developing streamlined systems that guarantee quality care and adherence to state, PACE, and organizational regulatory standards.


KEY RESPONSIBILITIES:


Achieve referral and enrollment targets established by management by fostering relationships with referral partners to create engagement opportunities with potential enrollees and their caregivers.

Ensure high levels of performance and efficiency in pre-enrollment verifications of Medicare, Medicaid, and PACE eligibility.

Provide education to referral sources, prospective participants/caregivers, and other relevant audiences regarding the benefits of the PACE program, as well as various initiatives and projects. Highlight differentiators from other healthcare options and identify key value propositions tailored to specific audience needs.


Deliver program education through lectures, presentations, events, meetings, or other necessary communications with community and business stakeholders to facilitate PACE referral generation.


Collaborate with the Events Supervisor to identify suitable events, community partners, or other resources and opportunities to educate the community about PACE while providing educational, technical, and administrative support for planning and execution.

Maintain up-to-date knowledge of all applicable CMS, DOH, and PACE-specific guidelines, including organizational and departmental policies and procedures.

Ensure compliance among staff with state and federal laws regarding Medicaid and Medicare Eligibility and Enrollment regulations.


Assist with intake activities as needed, including general qualification screening, documentation collection, benefit education/applications, site tours, home visits, and other follow-up to support the enrollment or education of a prospect.


Work closely with Intake Navigators and Account Managers to arrange in-home or virtual pre-enrollment assessment appointments with prospective participants.


Conduct pre-enrollment assessments using the UAS to evaluate the eligibility of prospective participants and confirm if they require more than 120 days of Community Based Long Term Care (CBLTC) Services.

Complete the Tasking Tool to determine suitable home assistance with ADLs/IADLs combined with attendance at the site.

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


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


Work with the participant and/or their family/caregiver to develop the 30-day service plan and obtain enrollment agreement documentation during home visits or other mutually agreed settings.


Assist with administrative functions of the program, including but not limited to, compiling informational handouts/packets from approved marketing materials, following up on referrals and appointments, and regularly tracking and reporting daily activities while compiling statistical data and reports.

Work collaboratively with Compliance and Marketing departments to develop necessary outreach and intake operations-related materials.


Provide recommendations on operational process improvements that may enhance enrollment turnaround, scheduling logistics, financial efficiencies, engagement strategies, reporting, and other critical touchpoints.

Regularly review key performance metrics and analytics to enhance process flows and/or quality of work.

Conduct interviews, hire, train, supervise, progressively discipline, and counsel all staff within the department.

Support new staff with onboarding to ensure a supportive, collaborative, and efficient transition to the Business Development and Clinical Intake Teams.

Meet organizational goals and adapt strategies as necessary.

Develop workflows and staffing plans in anticipation of new service areas.

Only operate within the scope of the individual's authority to practice.

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

Perform other duties as assigned.

QUALIFICATIONS:

Education:
Bachelor’s degree in Nursing or a related health field is preferred.

Experience:


A minimum of one (1) year of experience working with a frail or elderly population is required, or if the individual has less than one (1) year of experience, they must receive appropriate training from the PACE organization upon hiring.

Three to five (3-5) years of experience in geriatrics, home care, MLTC, MAP, D-SNP, and/or PACE long-term care products is preferred.

Knowledge of community-based long-term care services for dual eligible and frail adult populations is essential.


A comprehensive understanding of federal and state regulatory requirements regarding healthcare eligibility, coverage, and services of various public programs is necessary.

Familiarity with the Uniform Assessment System of New York (UAS-NY) is required.

Experience in working independently without significant oversight and/or direction from a supervisor is essential.

License:
Active and unrestricted New York State RN license is required.

Additional Requirements:


Must be legally authorized to practice in the State in which the healthcare professional will perform their duties.

Must be medically cleared for communicable diseases and have all immunizations up-to-date before engaging in direct participant contact.


Demonstrated excellent interpersonal skills, with the ability to manage situations requiring immediate and urgent attention while meeting targets and performing daily tasks.

Highly organized and adaptable to meet submission deadlines.

Provide exceptional customer service and communication with referral sources, prospects, and departments.

Excellent written and oral communication skills, with familiarity in medical terminology.

Proficiency in computer applications such as Word, Excel, and statistical analysis and reporting is required.

Preferred experience with Care Compass.

Language:
Bilingual skills are preferred.

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