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Niagara Falls. Community Enrollment Nurse. Kalos Health. FT. 1st Shift. Benefits.

Assess applicants in the community for eligibility and enrollment in our Managed Long Term Care program. Provides overview of program benefits to applicant, family member(s), and care giver(s). Completes medical and clinical assessments of applicant and develops personalized plans of care. They will serve to promote concise, effective assessments of members within their home environments as a means of capturing all elements of the medical, and psycho-social determinants to ensure appropriate service levels.

Key Responsibilities:

Conducts in-person or other DOH approved modality visit(s) to educate applicant, family and/or applicant's caregiver(s) on program benefits and design. In conjunction with the PCP, member and informal support systems, completes a comprehensive assessment within the consumer's home environment utilizing expert knowledge of the UAS instrument and clinical expertise to evaluate the member's need for services and technical eligibility. Manages an expected mean of 25 - 35 enrollment referrals monthly. Participates in training and guidance to new staff regarding policy & procedure(s), systemic tools, workload and overall functionality of this role within the interdisciplinary care team. Interacts with the consumer, family and informal support systems utilizing expertise of the UAS instrument and clinical knowledge to determine technical eligibility, medical history, current status and the identification of consumer's needs.
Utilizes designated criteria along with clinical knowledge and expertise to develop personalized plan of care. Negotiates appropriate care plan based on health assessments with health care providers, member and caregiver. Inputs visit and assessment data into the electronic health record timely (Tru Chart). May be requested to participate in quality initiatives and chart audits. Maintains regular communication with Enrollment Coordinators; Care Managers assigned; Care Coordinator and/or Director of Clinical Operations regarding status of the Members or concerns with meeting the technical eligibility within their prescribed caseload.

Qualifications/Requirements:

Licenses/Certifications: Current NYS RN license

Education: Associate's degree in Nursing

Experience:

Current NY State RN licensure. 5+ year's clinical experience, preferably in insurance field, home health or public health.
One year UAS experience.

Preferred Skills:

Demonstrates effective communication methods to assist in training and to relate effectively to upper management Assists in evaluating process improvements Ability to work independently, handle multiple assignments and prioritize workload
Demonstrates high level time management and priority setting Strong oral and written communication skills Ability to create, review and interpret treatment plans Demonstrates negotiation skills Demonstrates collegiality and teamwork and fosters same within their team. Able to effectively demonstrate critical thinking skills. Bilingual skills a plus

Work Environment

This job operates in the field with frequent travel to various counties and environments. This role routinely uses standard office equipment such as but not limited to computers, phones, photocopiers, document scanners, filing cabinets and fax machines.

This is a full-time hybrid position, and hours of work and days are Monday through Friday, with hours that may vary based upon operational and staff demands. Occasional evening, weekend and holiday work may be required.

Travel

This position requires frequent travel as an essential function to include home visits, covering 6 counties, off-site meetings or functions that may occur.

To apply, contact the employer on-line: Web-site: https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=e31e741b-73fc-442f-b209-58c7f0ebea88&ccId=1262596328337&lang=enUS