Clinical Assessment Manager

Overview

Conducts comprehensive assessment of member UAS-NY for potential new members and existing members' conditions clinical, environmental, and social to establish an individual plan of care needed to maintain the member safe in the community. Identifies solutions that promote high quality and cost-effective health care services. Manages requests for services from providers, members, and care management team and renders clinical determinations in accordance with VNS Health Plans policies as well as applicable state and federal regulations. Works under general supervision.

Responsibilities
• 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 or state-wide trends 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.
Qualifications

Licenses and Certifications:
Current license to practice as a Registered Professional Nurse in New York State required
Certified Case Manager preferred

Education:
Bachelor's Degree in nursing or equivalent work experience required
Master's Degree in nursing or equivalent work experience preferred

Work Experience:

• Minimum two years of clinical assessment, homecare or hospital experience required Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills required
• Demonstrated strong relationship management skills, including a high degree of psychological sophistication and non-aggressive assertiveness required
• Demonstrated successful conflict management skills and negotiation of “win-win” solutions required Working knowledge of Microsoft Excel, Power-Point, and Word required Knowledge of Medicaid and/or Medicare regulations required Working Knowledge of UAS-NY

 

About the Company:
VNS Health