Responsible for enrollment of new members by collaborating with caregivers and PCP
Provides assessment of newly referred patients, assess health needs and eligibility for managed long term care services.
Develops and implement treatment plans in conjunction with the Home Care Coordinator, Physician, and patient/caregiver.
Conferences with Enrollment Manager to assure appropriate services are in place.
Documents accurately and completely in patients EMR.
Submits written documentation on timely basis in accordance with DOH and Agency’s policy.
Responsible for conducting a minimum of 2 potential consumer’s assessment per work day throughout the Extended MLTC service area.
Makes referral for other services as needed.
Maintains updated professional knowledge and participates in patient education programs to ensure optimum quality of patient care.
Perform other nursing activities as directed.
Conducts comprehensive clinical, psycho-social, and financial risk assessments of potential members for enrollment to the MLTC program across multiple regions.
Evaluates appropriateness of membership based on UAS-NY assessment criteria.
Develops initial plan of care for new members, which includes selecting and authorizing services, supplies, equipment, environmental modification, durable medical equipment and medications, etc.
Identifies appropriate personal care service hours based on Personal Care Assessment/other appropriate tools and program guidelines; with member and family regarding level of service.
Obtain complete and accurate information for each potential enrollee. Approves eligibility of potential enrollee based on government standards and program criteria such as Universal Assessment Tool II, medical coverage, age, etc. Reviews application for completion and accuracy.
Stays abreast of current and potential changes to federal, state and local statutes and regulations and applicable quality assurance standards. Makes recommendations to of Enrollment Manager based on changes.
Makes recommendations in regard to enrollment policies and procedures. Adheres to MLTC rules and regulations.
Participates in special projects and performs other duties, as required.
Current New York State License as Registered Nurse
One (1) year general Medical – Surgical Nursing experience preferred
Able to meet health standards of employment
Must successfully complete orientation
Prior home care experience preferred
Must have valid driver license and working motor vehicle.