Conducts and reviews UAS-NY comprehensive assessments of potential and existing members. Establishes an individual Plan Of Care based on members clinical, environmental, and social needs to support member safety in the community. Identifies solutions that promote high quality and cost-effective health care services in accordance with VNS Health Plans policies, state and federal regulations.. Manages requests for services from providers, members, and care management team. Works under general supervision.
Requires weekly travel to Chenango / Putnam v isiting one county/day.
What We Provide:
What You Will Do:
• Conduct face-to-face or telehealth UAS-NY assessments according to state guidelines, policies, procedures, and protocols.• Utilize clinical skills to assess and document all aspects of the potential members long-term community-based needs.• Communicate with members, families, providers, and other parties as needed to complete an accurate comprehensive assessment.• Utilizes VNS Health and state-approved assessment questionnaire, guidelines, and documentation as well as interviews with members, family, and care providers in decision-making.• Performs in-home assessment for members who have identified significant changes in condition since last in-home assessment; provides comprehensive review and determination of member’s needs, including completion of UAS assessment questionnaire, tasking tool, and a projected service plan. Visits include all areas serviced by VNS Health Plans including upstate and downstate counties.• Performs in-home assessment on members to determine the appropriate service plan, including completion of UAS assessment questionnaire, tasking tool, and a projected service plan. Visits include all areas serviced by VNS Health Plans.• Explains VNS Health Plan benefits, including an explanation of the member's handbook.• Ensures compliance with state and federal regulatory standards and VNS Health Plans policies and procedures.• Identifies opportunities for alternative care options and contributes to the development of a safe member centered service plan.• Consult with supervisor and others in overcoming barriers in meeting goals and objectives.• Maintains current knowledge of organizational and state-wide regulations that affect member eligibility.• Coordinates with other departments, e.g. Care Management, Legal Affairs, Grievance and Appeals, Compliance, Membership Eligibility Unit, Quality as needed.• Participates in requests for out-of-network services when a member receives services outside of VNS Health Plans network services.• Keeps current with all health plan changes and updates through on-going training, coaching and educational materials. • Participates in special projects and performs other duties as assigned.
Licenses and Certifications:
Current license to practice as a Registered Professional Nurse in New York State requiredCertified Case Manager preferredValid driver's license or NYS Non-Driver photo ID card required as determined by operational/regional needs required
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