Clinical - Exception Template
2 months ago
SHIFT: This is a 8:30AM-5:00PM position (7.5 hours daily). Overtime may be required.
* Bilingual Spanish is a plus, predominantly a field position, Candidate should reside in or near the Bronx, UAS experience preferred,
Job Description: Long Term Care Nurse Specialist (Bronx, NY)
Position Purpose: Responsible for members gaining access to needed services through coordination and integration of medical and long term care services for the purpose of orientation, care plan development, assessment, and care coordination.
Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development
Monitor delivery of services and follow-up with members, caregivers, or providers through in person visits and telephonic contact
Authorize and coordinate referral for services
Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care
Assist in coordinating the development of informal or voluntary services to integrate into the member care plan
Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long term care services
Assist member with filing and resolving complaints and appeals
Direct care to participating network providers
Participate in care management committees and work on special projects related to care management as needed
Education/Experience: 3+ years of care management experience preferred, Home health, discharge planning, or long term care experience preferred.
Licenses/Certifications: Valid driver's license. NYS RN license required.
Pay Rate: $50 - 55.63/hr. ***
Walk me through the day to day responsibilities of this the role and a description of the project:
- RN must prep for the visit the morning of or afternoon before (Review of EMR and previous assessments)
- Be prepared to use critical thinking and problem solving skills.
- Travel to the members home to conduct the visit.
- Accurately document according to the provided documentation template which is a minimum of what is expected.
- Review all documentation and utilize Lenavi to identify inconsistencies that need to be corrected or validated.
- Complete and load supplemental tools and documents.
- Each day varies, nurse needs to be flexible with schedule and process changes, critical thinking and problem solving, prepared for travel, weather variability.
- Ability to be non-judgmental when visiting members homes and experiencing adverse events.
Describe the performance expectations/metrics for this individual and their team:
- Complete 2-5 visits depending on the type of visit assigned. Visits have different time allotments assigned based on what is required during the visit.
- Individuals that have MLTC, MAP or Maximus experience
- UAS RN
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