Job Description
Job Summary
Provides support for the completion of the Community Health Assessment (CHA) - formerly the UAS (Uniform Assessment System), initial assessments and reassessments based on New York state requirements, guidelines, and training provided by the company and/or outside resources. Completes enrollment paperwork materials required to appropriately process member applications for enrollment and CHA tasking tool in alignment with guidelines and training provided by the company and/or outside resources. Facilitates correction and revision of CHA paperwork and tasking tool documentation based on review and feedback provided through quality/review process.
Job Duties
• Completes approved New York State initial assessment tool and/or clinical reassessment used to define eligibility for community-based long-term care services for members.
• Completes enrollment paperwork, progress notes and tasking tool in member homes to assist in determining eligibility for services; reviews all data collected for accuracy and completion prior to submission.
• Charts all contacts and findings within appropriate tool and form per policy and procedure and within established deadlines.
• Attends training and continuing education sessions focused on the proper completion of Comprehensive Health Assessment (CHA) documentation, enrollment paperwork, and tasking tool.
• Focuses on continuous improvement and quality excellence in the completion of all materials associated with the initial enrollment/continued enrollment of members in the plan.
• Supports initiatives of the quality assessment and performance improvement committee.
• 25- 40% estimated local travel may be required (based upon state/contractual requirements).
Job Qualifications
Required Qualification:
• At least two years of clinical experience in managed care - including case management and home visit experience, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice (NY).
• Must reside in the state of New York or neighboring states (NJ, CT, parts of PA). Must have a NY state government ID.
• Trained and knowledgeable in the New York Uniform Assessment System (UAS).
• Must be able to travel to multiple boroughs via car or commuting public transportation.
• Understands and applies principles of care management and person-centered planning.
• Solid assessment skills.
• Understands and applies coverage guidelines and benefit limitations.
• Familiar with clinical needs and disease processes for chronic physical and behavioral illnesses.
• Understands and adapts appropriately to issues related to member communication, cognitive or other barriers.
• Organizational skills, and ability to prioritize and follow through on multiple projects in a timely manner.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.
Preferred Qualification:
• Certified Case Manager (CCM) or Chronic Care Professional (CCP).
• Home care or long-term care experience.
• Community support service experience accessing and using durable medical equipment (DME).
• Experience in utilization review, concurrent review and/or risk management.
• Bilingual or multi-lingual in Chinese (Mandarin or Cantonese), or Spanish.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.