Job Description

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Assessment Quality Review Specialist and Staff Educator is responsible for quality assurance, accuracy and overall integrity of the UAS-NY assessment data and visit documentation completed by core team nurses as well as, business partners’ nurses. This responsibility is fulfilled by performing assessment audits, identifying trends that require staff retraining, and implementing corrective action plans in collaboration with Clinical management staff. The position is also responsible for ongoing orientation, training and education of Assessment Nurses conducting UAS-NY assessments. He/She will participate in establishing educational modules for staff orientation and re-training. Position requires to travel as part of ongoing orientation, training and education, as well as to perform UAS-NY assessments on an as needed basis.Conduct Enrollment Visits follow up for HF nurses and business partners, including NTUC note completion, Visit Outcome Follow Up. Assist with completion of Deferral Calls, and Transfer Calls and notify appropriate parties of outcome. Maintain accurate productivity log of Enrollment processes follow-up. Prepare for RFS (Request for Service) and IDT (Interdisciplinary Team) meetings by conducting UAS-NY assessment review and relevant documentation conducted by core field staff and business partners to ensure correlation within the assessment and validation of Tasking Tool completion. Participate in RFS and IDT meetings, follow-ups with Assessment Nurses if documentations’ amendments are required. Identifies inconsistencies trends and provides suggestions for corrective action plan for identified assessment deficiencies to Field Assessment management. 

• Baccalaureate degree in nursing required

• Master's degree in nursing, education or related field preferred

• Minimum of two (2) years clinical experience required

• Managed Care experience preferred

• UAS-NY experience required

• Requires a NYS Registered Nurse license and registration

• Excellent analytical skills, interpretation of data

• Strong critical thinking skills

• Knowledge of Medicare and Medicaid regulations

• Ability to set priorities and to handle multiple assignments

• Working knowledge of audit techniques and methodologies

• Working knowledge of State and Federal regulations

• Travels to perform business partners training and clearance visits

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