Community Health Nursing Consultant

4 weeks ago

Tallahassee, Florida, United States State of Florida Full time
Job Summary

We are seeking a highly skilled Community Health Nursing Consultant to join our team at the State of Florida. As a key member of our Healthcare Quality and Clinical Management Unit, you will play a critical role in promoting an integrated, comprehensive, and cost-effective health care system with a focus on health equity and social determinants of health.

Key Responsibilities:

  • Provide on-going expertise, consultation, technical assistance, and monitoring for the Enhanced Care Coordination components of the CMS Managed Care Plan.
  • Collect, analyze, and report data pertaining to an integrated system of care, including Private duty nursing, Prescribed Pediatric Extended Care, and skilled nursing facility populations.
  • Serve as the subject matter expert and the Plan's liaison with the Agency for Health Care Administration and other program vendors for all ECC programs and services.
  • Participate, coordinate, and ensure CMS Plan vendor representation for all staffings, workgroups, and meetings related to ECC.
  • Perform programmatic clinical monitoring for the CMS Plan ECC populations, including enrollee record reviews, report reviews, program reviews, and contract reviews in a timely manner.
  • Maintain electronic files with written instructions for each component of the job, detailing who gets copied on emails, notifications, etc.
  • Monitor and lead initiatives for quality improvement projects in the area of enhanced care coordination.
  • Assist in investigation and resolution of member quality of care complaints when escalated to the CMS Managed Care Plan Central Office for clinical reasons related to ECC.
  • Provide technical assistance to contract vendors to meet reporting requirements with defined timeframes for assigned projects regarding enhanced care coordination.
  • Track and monitor disaster planning for CMS enrollees, including reviewing and tracking high-risk population emergency preparedness plans and collaborating with internal and external stakeholders to ensure enrollees have access to appropriate emergency sheltering as needed.
  • Work intensively with vendors related to recommendations and best practices for the enhanced care coordination program.
  • Work closely with the contracted vendor to ensure the required ECC reports and any ad hoc reports are complete and accurate.
  • Track ECC enrollees transitioning and aging out of CMS within the year to ensure all protocols are followed and for making the CARES referral as applicable.
  • Perform collection, analysis, and write-up of evaluation of the enrollee record reviews and reports related to enhanced care coordination.
  • Analyze QI data for reporting purposes, looking for trends.
  • Oversee and monitor the development, revision, and implementation of the care coordination/case management programs.
  • Provide leadership for implementing changes targeted at systems and process improvements, monitoring, and evaluating the effectiveness of these improvement projects.
  • Participate in professional development trainings and programs to gain and maintain knowledge of ECC, care coordination/case management, and managed care for children and youth with special health care needs.
  • Provide comprehensive updates and generate reports and presentations when needed regarding the status of the enhanced care coordination program.
  • Perform program monitoring (desk and on-site when needed) to ensure that all requirements of the AHCA contract and the contracted vendor contract are being met in relation to the enhanced care coordination program.
  • Review guidelines, statutes, and contract requirements related to enhanced care coordination to provide technical assistance to providers, vendors, and partners.
  • Ensure Nursing Facility enrollees have a completed and updated Individualized transition plan as required by AHCA guidelines.
  • Perform other related duties as assigned, including training new staff and assisting other unit members with assignments as needed.

Requirements:

  • Knowledge of care coordination/case management, enhanced care coordination, managed care, and CMS policies.
  • Proficient in Microsoft Office and strong computer skills.
  • Strong communication and presentation skills, training/meeting facilitation skills.
  • High degree of independence, flexibility, initiative, and commitment.
  • Knowledge of the principles and practices of program management and delivery of health services.
  • Knowledge of enhanced care coordination principles, practices, and techniques.
  • Ability to lead quality improvement projects and provide technical assistance.
  • Ability to apply the consultative process in problem-solving activities.
  • Ability to collect, interpret, and analyze statistical, demographic, and service data.
  • Ability to understand and apply applicable rules, regulations, policies, and procedures.
  • Ability to plan, organize, and coordinate work assignments.
  • Ability to communicate effectively, both written and verbal.
  • Ability to establish and maintain effective working relationships with others.
  • Ability to work with a team of other health care professionals.
  • Excellent organizational skills.
  • Excellent coordination skills, including multitasking and setting priorities on work assignments.
  • Excellent time management skills.
  • Excellent writing, research, analytical skills.
  • Demonstrates problem-solving, leadership, conflict management, and team-building skills to ensure a productive work environment and achievement of goals.
  • Some travel may be required.
  • Registered Nurse License required.

Qualifications:

  • This position is required to have and maintain a clear and active license as a Registered Nurse or be eligible to practice nursing in accordance with the Florida Administrative Code as defined by the Florida Board of Nursing.
  • Years of Experience: 1-3 Years of pediatric clinical experience preferred.

Benefits:

  • Annual and Sick Leave benefits.
  • Nine paid holidays and one Personal Holiday each year.
  • State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance options.
  • Retirement plan options, including employer contributions.
  • Flexible Spending Accounts.
  • Tuition waivers.
  • And more.

How to Apply:

Please submit your application through the People First Service Center. Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

Equal Opportunity Employer:

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer and does not tolerate discrimination or violence in the workplace.

Veterans' Preference:

Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans' Preference will receive preference in employment for Career Service vacancies and are encouraged to apply.

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