Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

UAS Assessment Nurse, LTSS (NYC Based)

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Clinical
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EmblemHealth
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Summary of Job:

Assess eligibility of members in need of community based long term support services (CBLTSS). Conduct UAS assessment in the members home or by telehealth (under NY State’s regulations), and at skilled nursing facilities. Consult with health care providers to support assessment outcomes. Conduct needs assessment utilizing the UAS-NY/DOH tool to determine members’ qualification for Long Term Care services. Complete the Community Health Assessment (CHA) Variance Resolution process (clinical disputes).

Responsibilities:

  • Conduct quality assurance review of completed UAS assessments in UAS-NY database for EmblemHealth members.
  • Comply with NY State DOH guidelines on completion and timely finalization of all UAS assessments.
  • Collaborate with member, caregiver, Maximus, and the plan to ensure three-way calls are completed for initial and expedited assessments.
  • Submit completed assessments timely to EmblemHealth, completing member correspondence with quality and efficiency.
  • Maintain knowledge of all applicable NYSDOH/CMS guidelines and relevant organizational and departmental policies and procedures.
  • Escalate questions or concerns during the program assessment and enrollment process to the leadership team and or NYIA to ensure proper completion of UAS-NY and handling of issues that may require intervention.
  • Support an integrated care model tapping into appropriate resources both internally and external to the organization.
  • Enter and maintain documentation in the Electronic Medical Records System (EMR), meeting defined timeframes and performance standards.
  • Maintain an understanding of Care Management principles, program objectives and design, implementation, management, monitoring, and reporting.
  • Actively participate on assigned committees and meetings to support LTSS program functions.
  • Attend and complete all department-mandated training as well as satisfy educational in-service requirements.
  • Perform other related projects and duties as assigned.
  • Act as the member’s advocate and liaison by completing or facilitating interventions with providers and/or private, non-profit, and governmental agencies.

Qualifications:

  • Associate or Baccalaureate degree in nursing
  • Active New York State Registered Nursing (RN) license in good standing
  • UAS-NY certification
  • One year experience in MLTC, LTSS or home care (Preferred)
  • 4 – 6+ years of relevant, professional nursing experience (Required)
  • Experience with NYSDOH Medicaid program requirements and benefits under Long Term Care Proficiency in utilizing and analyzing UAS-NY assessments and assessment outcomes (Required)
  • Organization/prioritization ability; and the ability to effectively manage a caseload of highly complex members (Required)
  • Experience with Long-term Services and Supports (LTSS), Managed Long Term Care (MLTC) (Required)
  • Strong communication skills (verbal, written, presentation, interpersonal) (Required)
  • Computer proficiency: MS Office (Word, Excel, Outlook, TEAMS); mobile technology (wireless phone/laptop, etc.) (Required)
  • System user experience in a highly automated environment (Required)
  • Strong cross-group collaboration, teamwork, problem solving, and decision-making skills (Required)
  • Ability to work a flexible schedule (evenings, weekends, and holidays) to meet member and/or caregiver and departmental scheduling needs (Required)
  • Ability to conduct field-based and telehealth assessments (50% in field, 50% telephonic) (Required)
  • Ability to complete 2-3 assessments per day (Required)

Security Disclosure

If you are offered a job from one of the EmblemHealth family of companies that includes ConnectiCare, AdvantageCare Physicians, and WellSpark, the offer confirmation email will come from “HRTalentAcquisition” with the subject line: “Offer of Employment for (job title)” – Please respond online”.

 

We never ask you to join a Google Hangout, request you to purchase your own equipment or pay to apply. We do not send email from a third-party email service such as Yahoo or Gmail. 

Pay Disclosure

A good faith estimate of the compensation range for individuals hired to work for the EmblemHealth Family of Companies is provided. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, internal peer equity, and market and business considerations. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. It is not typical for an individual to be hired at or near the top of the range, as compensation decisions depend on each case’s facts and circumstances. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract.

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives, and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy or related condition, marital status, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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