Field Nurse Evaluator

2 weeks ago

Kingston, New York, United States Maximus Full time

Job Summary

Maximus is seeking a Field Registered Nurse to support our C-YES Program. This is a full-time, hybrid-remote position that requires travel throughout the territories of Kingston, Oneonta, Newburgh, and Middletown, New York.

About the Role

The Field Nurse Evaluator will conduct strength-based assessments for families with children (ages 0-21) with behavioral health/psychiatric issues. They will work in the community, conducting 1-2 assessments per day, and collaborate with a Family Support Coordinator to meet the family's case management needs.

Responsibilities

  • Review 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.
  • Develop Home and Community Based Services (HCBS) Plan of Care (POC) in collaboration with child and family.
  • Perform in-home visits to assess children and guide the development of individualized HCB Service plans.
  • Collect and review child's clinical documentation and/or health referral, as relevant to the case.
  • Utilize the HCBS portion of the State CANS assessment tool and MAXIMUS case management systems to document the child's health status, strengths, care needs, diagnoses, and preferences.
  • Properly document any concerns, conflicting information, or other issues that surface during the evaluation process.
  • Emphasize continuity of care, reducing or eliminating fragmentation, duplication, and gaps in treatment plans.
  • 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 the target population.

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 complex tasks simultaneously.
  • Strong ability to work independently.

Preferred Requirements

  • Bachelor's Degree in Nursing and/or equivalent certification.
  • Home care experience using the UAS-CANS-NY system.
  • RN experience in a psychiatric/behavioral health/pediatrics/adolescent/foster care settings/group home/school nurse/care management.
  • Consistent technological experience using computer systems for assessments/word processing tasks.

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