Description & Requirements
Maximus is currently hiring for a Field Registered Nurse - Home Care to support our C-YES Program (Children and Youth Evaluation Services). This is a full-time, hybrid-remote position that will require travel throughout territories of Watertown, Jefferson, Lewis, St. Lawrence, Franklin, Clinton, Essex, Herkimer, Hamilton, Fulton, Montgomery, Warren, Saratoga, and Schenectady, New York.
Maximus has partnered with the New York State Department of Health to establish the Children and Youth Evaluation Service (CYES) program to determine whether a child or youth is eligible for home and community-based services (HCBS) covered by Medicaid. The Field Nurse Evaluator will be working in the community conducting strength-based assessments for families who have children (ages 0-21) with behavioral health/psychiatric issues. All nurses are provided support and education for ongoing professional development and annual certification in the CANS-NY assessment tool. The assessments will be the basis for family-driven Plan of Care (POC) development to support the family’s access to Home and Community Based Services (HCBS). The Nurse Evaluator will conduct 1-2 assessments a day and work with a Family Support Coordinator to meet the family’s case management needs specifically related to the HCBS POC.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Develop Home and Community Based Services (HCBS) Plan of Care (POC) in collaboration with child and family that includes evaluation of physical, developmental, and/or mental health status.
- Perform in-home visits to assess children that includes evaluation of health status, strengths, care needs, and preferences and guide the development of individualized HCB Service plans.
- Collect and review child’s clinical documentation and/or health referral, as relevant to the case.
- Utilize the HCBS portion of the State CANS assessment tool and MAXIMUS case management systems to document the child’s health status, strengths, care needs, diagnoses and preferences and transmit, as required.
- Properly document any concerns, conflicting information, other issues that surface during the evaluation process.
- Emphasize continuity of care, thus reducing or eliminating fragmentation, duplication, and gaps in treatment plan.
- Discuss with child/family health care options, supports needed, service vendor options and waiver options.
- Update plans of care as per State requirements, and on an as needed basis.
- Collaborate with Family Support Coordinators to meet the needs of the family.
- Enhance communication and collaborative relationships with interdisciplinary care team members to improve care coordination and facilitate service delivery.
- Collect quality review data and any required documentation to support outcome measurements and record case notes into CRM.
- Provide relevant information in response to the child’s specific needs as a bridge between when the in-home evaluation is conducted and evaluation results are provided.
- Maintain a comprehensive working knowledge of community resources and network services for target population.
- Meets all standards established for this position as outlined in the corresponding annual performance criteria and bonus template for this position.
- Performs other duties as may be assigned by the Regional Manager or other project management.
Minimum Requirements:
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Graduate of an accredited nursing program.
- Active RN Licensure in the state of New York.
- 2+ years relevant experience as an RN.
- Active and valid New York driver’s license.
- Required ability to travel throughout assigned region, based on business needs.
- Must have reliable form of transportation.
- Ability to review health status questions and make evaluations and determinations based on the UAS-CANS-NY system criteria for enrollment; ability to work with technology in the workplace.
- Knowledge of the theory, principles, and practices of general professional nursing.
- Knowledge of state and agency laws and regulations governing general professional nursing practices.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Ability to communicate and work effectively with multi-generational consumers.
- Ability to demonstrate sensitivity to the concerns of others.
- Ability to perform comfortably in a fast-paced, deadline-oriented work environment.
- Ability to successfully execute many complex tasks simultaneously.
- Strong ability to work independently.
Preferred Requirements:
- Bachelor’s Degree in Nursing and/or equivalent certification.
- Home care experience using the UAS-CANS-NY system.
- RN experience in a psychiatric/behavioral health/pediatrics/adolescent/foster care settings/group home/school nurse/care management.
- Consistent technological experience using computer systems for assessments/word processing tasks.
- Experience in developing Plans of Care.
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